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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 OrthosesExternal website

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

Knee Orthoses PAExternal website

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 PAExternal website

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 PAExternal website

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.

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