LCD

Automatic External Defibrillators LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

• Revised: "ordering physician" to "treating practitioner"
• Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
• Added: Statement to refer to ICD-10 code section in the LCD-related Policy Article
• Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

APPENDICES:

• Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
• Added: Statement to refer to ICD-10 code section in the LCD-related Policy Article

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Automatic External Defibrillators PA

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

• Removed: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g) section

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

• Added: Section and related information based on Final Rule 1713

CODING GUIDELINES:

• Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

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"

02/06/2020: 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.

LCD

Bowel Management Devices LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

• Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Bowel Management Devices PA

Revision Effective Date: 01/01/2020

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

• Added: Section and related information based on Final Rule 1713

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"

02/06/2020: 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.

LCD

Canes and Crutches LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

• Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
• Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act , these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Canes and Crutches PA

Revision Effective Date: 01/01/2020

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

• Added: Section and related information based on Final Rule 1713

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"

02/06/2020: 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.

LCD

Cervical Traction Devices LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

• Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
• Revised: "ordering physician" updated to "treating practitioner"

GENERAL:

• Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/06/2020: Pursuant to the 21st Century Cures Act , these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Cervical Traction Devices PA

Revision Effective Date: 01/01/2020

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

• Removed: Due to Final Rule 1713

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

• Added: Section information based on Final Rule 1713

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"

02/06/2020: 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.

LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

• Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
• Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

• Revised: "ordering physician" to "treating practitioner"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

• Revised: "attending physician" to "treating practitioner"
• Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

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

• Added: Section and related information based on Final Rule 1713

DME INFORMATION FORM (DIF):

• Revised: "ordering physician" to "treating practitioner"
• Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

CODING GUIDELINES:

• Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

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"

02/06/2020: 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.

LCD

External Breast Prostheses LCD

Revision Effective Date: 01/01/2020

GENERAL:

• Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

• Revised: "ordering physician" to "treating practitioner"

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/06/2020: Pursuant to the 21st Century Cures Act , these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

External Breast Prostheses PA

Revision Effective Date: 01/01/2020

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

• Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

• Revised: "physician" to "treating practitioner"

02/06/2020: 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.

LCD

Heating Pads and Heat Lamps LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

• Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Heating Pads and Heat Lamps PA

Revision Effective Date: 01/01/2020

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

• Added: Section and related information based on Final Rule 1713

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"

02/06/2020: 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.

LCD

High Frequency Chest Wall Oscillation Devices LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

• Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
• Added: Statement to refer to ICD-10 code list in the LCD-related Policy Article
• Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

High Frequency Chest Wall Oscillation Devices PA

Revision Effective Date: 01/01/2020

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

• Removed: Statement that the diagnosis code, that justifies the need for the items, must be billed on the claim
• Removed: Section due to Final Rule 1713

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

• Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

• Added: Statement that the diagnosis code, that justifies the need for the items, must be billed on the claim

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"

02/06/2020: 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.

LCD

Hospital Beds And Accessories LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

• Revised: Order information as a result of Final Rule 1713

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Hospital Beds And Accessories PA

Revision Effective Date: 01/01/2020

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

• Removed: Due to Final Rule 1713

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

• Added: Section information based on Final Rule 1713

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"

02/06/2020: 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.

LCD

Immunosuppressive Drugs LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

• Revised: "physician" to "treating practitioner"

GENERAL:

• Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

• Revised: "ordering physician" to "treating practitioner"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Immunosuppressive Drugs PA

Revision Effective Date: 01/01/2020

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

• Added: Section and related information based on Final Rule 1713

MODIFIERS:

• Revised: "ordering physician" 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"

02/06/2020: 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.

LCD

Intravenous Immune Globulin LCD

Revision Effective Date: 01/01/2020

GENERAL:

• Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

• Revised: "ordering physicians" to "treating practitioners"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Intravenous Immune Globulin PA

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

• Revised: "physician" to "practitioner"

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

• Added: Section and related information based on Final Rule 1713

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"

02/06/2020: 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.

LCD

Mechanical In-exsufflation Devices LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

• Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
• Added: Statement to refer to ICD-10 code list in the LCD-related Policy Article

GENERAL:

• Revised: Order information as a result of Final Rule 1713

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Mechanical In-exsufflation Devices PA

Revision Effective Date: 01/01/2020

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

• Removed: Due to Final Rule 1713

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

• Added: Section information based on Final Rule 1713

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"

02/06/2020: 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.