Skip to Main Content

Print | Bookmark | Email | Font Size: + |

April 21, 2022

LCD and Policy Article Revisions Summary for April 21, 2022

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. The policy included is Nebulizers. Please review the entire LCD and related PA for complete information.

Nebulizers

LCD

Nebulizers LCDExternal website

Revision Effective Date: 06/05/2022

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: Group 3 Codes reference for small volume nebulizer (A7003, A7004, A7005) and related compressor (E0570)
  • Revised: Language regarding coverage of E0574, to include administration of Treprostinil inhalation solution to beneficiaries with pulmonary hypertension only and reference to Group 11 Codes in the LCD-related PA
  • Revised: Coverage criteria for treprostinil and iloprost
  • Added: Separate criteria language for iloprost
  • Removed: Thromboembolic disease of the pulmonary arteries from criteria for treprostinil and iloprost
  • Added: Criterion 4 to treprostinil coverage criteria and reference to Group 11 Codes in the LCD-related PA
  • Added: Reference to Group 14 Codes in the LCD-related PA for iloprost

SUMMARY OF EVIDENCE:

Added: Information related to treprostinil inhalation solution for PH-ILD and related to iloprost and treprostinil inhalation solution for CTEPH

ANALYSIS OF EVIDENCE:

  • Added: Information related to treprostinil inhalation solution for PH-ILD and related to iloprost and treprostinil inhalation solution for CTEPH

BIBLIOGRAPHY:

  • Added: Section related to treprostinil inhalation solution for PH-ILD and related to iloprost and treprostinil inhalation solution for CTEPH

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments (A59085)

PA

Nebulizers PAExternal website

Revision Effective Date: 06/05/2022

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Removed: HCPCS codes K0730 and Q4074 from Group 11 Paragraph
  • Added: ICD-10-CM code I27.23 to Group 11 Codes
  • Removed: ICD-10-CM code I27.24 from Group 11 Codes
  • Added: Group 14 Paragraph for HCPCS codes K0730 and Q4074
  • Added: Group 14 Codes section for ICD-10-CM codes

04/21/2022: At this time the 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/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved