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April 12, 2018

Policy Article Revisions Summary for April 12, 2018

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Facial Prostheses, Knee Orthoses, Lower Limb Prostheses, Manual Wheelchair Bases, Nebulizers, Pneumatic Compression Devices, Power Mobility Devices, Speech Generating Devices, Tracheostomy Care Supplies, Wheelchair Options/Accessories, and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.

Facial Prostheses

Policy Article

Facial Prostheses Policy ArticleExternal Website

Revision Effective Date: 01/01/2018

  • Added: Clarifying language regarding use of miscellaneous code L8048

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Knee Orthoses

Policy Article

Knee Orthoses Policy ArticleExternal Website

Revision Effective Date: 01/01/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: "Spinal" to "knee", in reference to OTS language

CODING GUIDELINES:

  • Update: Velcro and Kevlar to include trademark

04/05/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Lower Limb Prostheses

Policy Article

Lower Limb Prostheses Policy ArticleExternal Website

Revision Effective Date: 01/01/2018

CODING GUIDELINES:

  • Revised: "liner" to "insert" for continuity of terms
  • Added: Coding guidelines for prosthetic covers (L5704-L5707) and Protective outer surface covering systems (L5962, L5964, and L5966)
  • Added: Bundling table for Coding Batteries and Chargers Concurrently With a Powered Base Item

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Manual Wheelchair Bases

Policy Article

Manual Wheelchair Bases Policy ArticleExternal Website

Revision Effective Date: 01/01/2018

CODING GUIDELINES:

  • Added: Clarification of what is included in a manual wheelchair base code
  • Added: Clarification of titanium unbundling in manual wheelchair bases

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Nebulizers

Policy Article

Nebulizers Policy ArticleExternal Website

Revision Effective Date: 01/01/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Dispensing Fee billing timeline for refill prescriptions

CODING GUIDELINES:

  • Added: Billing instructions for accessories used in conjunction with E0574

04/05/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Pneumatic Compression Devices

Policy Article

Pneumatic Compression Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2017

CODING GUIDELINES:

  • Revised: Coding guidelines for clarification

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Power Mobility Devices

Policy Article

Power Mobility Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2018

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: 42 CFR(c) and (g) language, previously in Policy Specific Documentation section

POLICY SPECFIC DOCUMENTATION:

  • Revised: ADMC eligible base codes to conform to the Condition of Payment PA Program
  • Added: Prior Authorization of Power Mobility Devices (PMD) Demonstration and Condition of Payment PA Program information

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Speech Generating Devices

Policy Article

Speech Generating Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2017

CODING GUIDELINES:

  • Added: Coding Verification Review for E2510

04/05/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Tracheostomy Care Supplies

Policy Article

Tracheostomy Care Supplies Policy ArticleExternal Website

Revision Effective Date: 01/01/2017

CODING GUIDELINES:

  • Added: Clarification that tracheostomy tubes (A7520, A7521, 7522) are all-inclusive

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Wheelchair Options/Accessories

Policy Article

Wheelchair Options/Accessories Policy ArticleExternal Website

Revision Effective Date: 01/01/2018

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: 42 CFR language previously in Policy Specific Documentation section

CODING GUIDELINES:

  • Revised: Coding Guidelines for E1012
  • Added: PDAC contact information

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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Wheelchair Seating

Policy Article

Wheelchair Seating Policy ArticleExternal Website

Revision Effective Date: 01/01/2018

CODING GUIDELINES:

  • Revised: Positioning cushion language placement for clarification
  • Added: Wheelchair seat and back cushion codes are all-inclusive

04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

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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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