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June 25, 2020

LCD and Policy Article Revisions Summary for June 25, 2020

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

Lower Limb Prostheses

PA

Lower Limb Prostheses PAExternal Website

Revision Effective Date: 08/01/2020

CODING GUIDELINES:

  • Added: Coding guidelines for HCPCS codes L5856, L5857, L5858, L5980, L5981, and L5987

CODING VERIFICATION REVIEW:

  • Added: Section header for information related to PDAC coding verification review
  • Revised: PDAC coding verification review information for HCPCS code L5969, to include effective for DOS on or after 01/01/2014
  • Added: PDAC coding verification review information for HCPCS codes L5856, L5857, L5858, L5973, L5980, and L5987, effective for DOS on or after 01/01/2021

06/25/2020: 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 LCDExternal Website

Revision Effective Date: 01/01/2020

CPT/HCPCS CODES:

  • Corrected: Descriptor for the A9 modifier to include “or more” in Group 1 Paragraph

06/25/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-substantive corrections.

PA

Surgical Dressings PAExternal Website

Revision Effective Date: 01/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: Included descriptor of the A9 modifier

06/25/2020: 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.

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