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January 9, 2020

LCD and Policy Article Revisions Summary for January 9, 2020

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are Power Mobility Devices and Surgical Dressings. Please review the entire LCDs and related PAs for complete information.

Power Mobility Devices

LCD

Power Mobility Devices LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

Removed: 7-element order requirement
Added: SWO requirement

MISCELLANEOUS:

Removed: Information indicating delivery of PMD must be completed within 120 days following completion of the face-to-face examination

GENERAL:

Removed: Order information from section

GENERAL DOCUMENTATION REQUIREMENTS:

Revised: "Prescriptions (orders)" to "SWO"

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: 7-element order requirements
Removed: Detailed Product Description (DPD) information
Revised: References of face-to-face "examination" to face-to-face "encounter"
Removed: Requirement of date stamp or equivalent
Revised: Header "FACE-TO-FACE EXAMINATION" to "FACE-TO-FACE ENCOUNTER"
Revised: References of "practitioner" to "treating practitioner"

Policy Article

Power Mobility Devices Policy Article

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Removed: 7-element order and Detailed Product Description direction
Added: SWO direction
Revised: References of face-to-face "examination" to face-to-face "encounter"
Revised: Face-to-face encounter language and references of "practitioner" updated to "treating practitioner"
Added: Face-to-Face encounter must be completed within 6 months prior to the order
Removed: References to 45-day timeframe for receipt of order and face-to-face

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(c) and 42 CFR 410.38(g):

Removed: Entire section based on Final Rule 1713

FACE-TO-FACE ENCOUNTER:

Revised: Section header "FACE-TO-FACE EXAMINATION" to "FACE-TO-FACE ENCOUNTER," updated section language based on Final Rule 1713, and reference to 42 CFR Section 414.224(a) for customized DME
Removed: References to 45-day timeframe for receipt of face-to-face
Removed: Reference to the Medicare Claims Processing Manual for customized DME

MISCELLANEOUS:

Removed: MISCELLANEOUS section including ADMC and Condition of Payment Prior Authorization (PA) Program-specific information

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

01/09/2020: 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.

Surgical Dressings

LCD

Surgical Dressings LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: References to Detailed Written Order (DWO)
Revised: "ordering physician" updated to "treating practitioner"

GENERAL:

Added: References to Standardized Written Order (SWO)

GENERAL DOCUMENTATION REQUIREMENTS:

Revised: "Prescriptions (orders)" to "SWO"

Policy Article

Surgical Dressings Policy Article

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217)

Added: Entire section regarding the new rule

QUALIFYING WOUND:

Revised: "physician" updated to "treating practitioner"

MISCELLANEOUS:

Revised: "physician" updated to "treating practitioner"

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Revised: Statement "The order must specify" and updated to "For initial wound evaluations, the treating practitioner's medical record, nursing home, or home care nursing records must specify:"
Added: Additional requirements to "For initial wound evaluations, the treating practitioner's medical record, nursing home, or home care nursing records must specify"
Revised: "physician" updated to "treating practitioner"

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

01/09/2020: 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 PAs. For complete information on any topic, you must review the LCDs and/or PAs.

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

LCD and Policy Article Revisions Summary for January 9, 2020

Power Mobility Devices

LCD

Policy Article

Surgical Dressings

LCD

Policy Article

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