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May 4, 2023

Policy Article Revisions Summary for May 4, 2023

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are High Frequency Chest Wall Oscillation Devices, Immunosuppressive Drugs and Ostomy Supplies. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

High Frequency Chest Wall Oscillation Devices

PA

High Frequency Chest Wall Oscillation Devices PAExternal website

Revision Effective Date: 05/04/2023

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: ICD-10-CM code G80.0 to Group 1 Codes

05/04/2023: At this time 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.

Immunosuppressive Drugs

PA

Immunosuppressive Drugs PAExternal website

Revision Effective Date: 01/01/2023

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: “PA” to “pancreas transplant alone”

05/04/2023: At this time 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.

Ostomy Supplies

PA

Ostomy Supplies PAExternal website

Revision Effective Date: 01/01/2022

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: “Claims for tape and adhesive (A4450, A4452, A5120) that are billed without an AU modifier or another modifier indicating coverage under a different policy will be rejected as missing information.”

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: “Claims for tape and adhesive (A4450, A4452, A5120) that are billed without an AU modifier or another modifier indicating coverage under a different policy will be rejected as missing information.”
  • Removed: “Claims lines for A4450, A4452 and A5120 billed without AU modifier will be rejected as missing information.”

05/04/2023: At this time 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/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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