November 19, 2020
Policy Article Revisions Summary for November 19, 2020
Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Ankle-Foot/Knee-Ankle-Foot Orthoses, Knee Orthoses, Spinal Orthoses: TLSO and LSO and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related PAs for complete information.
Ankle-Foot/Knee-Ankle-Foot Orthoses
PA
Ankle-Foot/Knee-Ankle-Foot Orthoses
Revision Effective Date: 02/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: Prefabricated orthoses (OTS or custom-fit) incorrect coding denial language, by removing "with a statutory denial"
- Added: Definitions of prefabricated and custom fabricated orthoses
- Clarified: Billing of custom fabricated additions
CODING GUIDELINES:
- Added: Coding guideline information for HCPCS code L2005
11/19/2020: 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.
Knee Orthoses
PA
Revision Effective Date: 02/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: Denial language for custom fitted orthoses to remove "with a statutory denial"
11/19/2020: 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.
Spinal Orthoses: TLSO and LSO
PA
Spinal Orthoses: TLSO and LSO PA
Revision Effective Date: 02/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: Prefabricated orthoses (OTS or custom-fit) incorrect coding denial language, by removing "with a statutory denial"
- Added: Definitions of prefabricated and custom fabricated orthoses
- Clarified: Billing of custom fabricated additions
11/19/2020: 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.
Therapeutic Shoes for Persons with Diabetes
PA
Therapeutic Shoes for Persons with Diabetes PA
Revision Effective Date: 11/05/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: Certifying physician information, to clarify NPs or PAs practicing 'incident to' supervising physician
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Revised: "detailed written order" to "SWO"
- Revised: Certifying physician information, to clarify NPs or PAs practicing 'incident to' supervising physician
11/19/2020: 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.