LCD

Ankle-Foot/Knee-Ankle-Foot Orthosis 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

HCPCS CODES:

• Revised: HCPCS L2006 code description per quarterly HCPCS code update

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/20/2020: 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). During the exercise of listing individual HCPCS codes, L2006 had been inadvertently added because it fell within a code span and is being deleted.

PA

Ankle-Foot/Knee-Ankle-Foot Orthosis 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: "ordering physician's" to "treating practitioner's"
• Revised: "physician's" to "practitioner's"
• 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
• Added: Coding Guidelines for L1900, L1902, L1904, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1970, L1971, L1980, and L1990
• Revised: L1906 Coding Guideline
• Revised: L2006 Coding Guideline per quarterly HCPCS code update
• Removed: HCPCS K0903
• Added: HCPCS A5514, crosswalk from K0903
• Removed: Reference of effective DOS for K0903
• Added: Reference of effective DOS for A5514

02/20/2020: 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

Eye Prostheses LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/20/2020: 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

Eye Prostheses PA

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

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

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's" to "treating practitioner's"

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"

02/20/2020: 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

Facial Prostheses LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/20/2020: 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

Facial 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's" to "treating practitioner's"

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"

02/20/2020: 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

Glucose Monitors 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: "physician" to "treating practitioner"
• Revised: "treating physician" to "treating practitioner"
• Revised: "month" to "30 days," as clarification of billing K0553
• 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"

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

GENERAL DOCUMENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

APPENDICES:

• Revised: "physician" to "practitioner"

02/20/2020: 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

Glucose Monitors PA

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

• Removed: STATUTORY ORDER REQUIRMENTS section
• 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

MODIFIERS:

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

CODING GUIDELINES:

• Clarified: Coding guideline related to K0553 billing timeline
• 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"

02/20/2020: 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

Manual Wheelchair Bases LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/20/2020: 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

Manual Wheelchair Bases 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 42 CFR 410.38(g):

• 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:

• 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"

02/20/2020: 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

Orthopedic Footwear LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

• Revised: 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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/20/2020: 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

Orthopedic Footwear PA

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

• Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
• Removed: Therapeutic Shoes for Persons with Diabetes codes, leaving reference to the policy

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
• Removed: Therapeutic Shoes for Persons with Diabetes codes, leaving reference to the policy

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"

02/20/2020: 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

Ostomy Supplies 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"

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/20/2020: 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

Ostomy Supplies 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

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"

02/20/2020: 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: "ordering physician" to "treating practitioner"

NUTRIENTS:

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

EQUIPMENT AND SUPPLIES:

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

GENERAL:

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

REFILL REQUIREMENTS:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/20/2020: 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"

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

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

02/20/2020: 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

Patient Lifts LCD

Revision Effective Date: 01/01/2020

GENERAL:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/20/2020: 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

Patient Lifts 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"

02/20/2020: 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

Pneumatic Compression Devices LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

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

GENERAL:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/20/2020: 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

Pneumatic Compression Devices PA

Revision Effective Date: 01/01/2020

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

• Removed: Entire section based on 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

CERTIFICATE OF MEDICAL NECESSITY (CMN):

• Revised: Section header to remove PIM reference
• Revised: "physician" to "treating practitioner"
• Revised: Detailed Written Order to SWO
• Removed: CMN DME form version number

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"

02/20/2020: 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

Suction Pumps 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

REFILL REQUIREMENTS:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/20/2020: 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

Suction Pumps 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

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"

02/20/2020: 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

Walkers LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

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

CODING INFORMATION:

• Removed: Field titled "Bill Type"
• Removed: Field titled "Revenue Codes"
• Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
• Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
• Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUENTATION REQUIREMENTS:

• Revised: Prescriptions (orders) to SWO

02/20/2020: 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

Walkers 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

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"

02/20/2020: 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.