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March 25, 2021

Policy Article Revisions Summary for March 25, 2021

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Canes and Crutches, Eye Prostheses, Facial Prostheses, Manual Wheelchair Bases, Nebulizers, Power Mobility Devices, Wheelchair Options/Accessories, and Wheelchair Seating. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Canes and Crutches

PA

Canes and Crutches PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Non-coverage language for white canes and added NCD reference

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Eye Prostheses

PA

Eye Prostheses PAExternal Website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Removed: Trademark symbols from PROSE references, per AMA guidelines

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Facial Prostheses

PA

Facial Prostheses PAExternal Website

Revision Effective Date: 01/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Modifiers section and related information for modifiers AV, KM, KN, RT and LT

CODING GUIDELINES:

  • Removed: KM and RT/LT modifier instructions. Relocated to Modifiers section within Policy Specific Documentation Requirements

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Manual Wheelchair Bases

PA

Manual Wheelchair BasesExternal Website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Added: Coding verification review information for HCPCS code K0009 (effective for dates of service on or after 06.01.2013)
  • Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review
  • Removed: Reference to HCPCS codes for billing of maintenance and service

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Nebulizers

PA

Nebulizers PAExternal Website

Revision Effective Date: 05/17/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: Trademark symbol from Foradil Aerolize, per AMA guidelines
  • Revised: Day references to include hyphen

CODING GUIDELINES:

  • Added: "(CVR)" after reference to coding verification review
  • Added: "(PCL)" after reference to "Product Classification List"
  • Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review
  • Added: HCPCS codes J7605, J7606, and J7686 to statement regarding KP KQ modifiers

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Power Mobility Devices

PA

Power Mobility Devices PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: "physician's" to "practitioner's"

MISCELLANEOUS:

  • Revised: "coding verification determination" to "coding verification review"
  • Added: "CVR" after reference to "coding verification review"
  • Added: "PCL" after reference to "Product Classification List"
  • Revised: Coding verification review reference of "devices" to "products"
  • Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Wheelchair Options/Accessories

PA

Wheelchair Options/Accessories PAExternal Website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Removed: Reference to HCPCS codes for replacement-only items

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Wheelchair Seating

PA

Wheelchair Seating PAExternal Website

Revision Effective Date: 10/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: References to refer to group codes in the ICD-10 code list section

CODING GUIDELINES:

  • Revised: References of positioning back cushion HCPCS codes, from "E2314" and "E2315" to "E2614" and "E2615" respectively
  • Added: HCPCS code E2610 to list of HCPCS codes for which products require written coding verification review
  • Added: "CVR" after reference to "coding verification review"
  • Added: "(PCL)" after reference to "Product Classification List"
  • Revised: Coding verification review language for products that must be billed with HCPCS code K0669
  • Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Note: The information contained in this article is only a summary of revisions to the LCDs and PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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