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June 22, 2023

LCD and Policy Article Revisions Summary for June 22, 2023

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are External Infusion Pumps and Intravenous Immune Globulin. Please review the entire LCDs and related PAs for complete information.

External Infusion Pumps

LCD

External Infusion Pumps LCDExternal Website

Revision Effective Date: 07/01/2023

CODING INFORMATION:

  • Added: J1811 and J1813 to Group 4 Codes

06/22/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

External Infusion Pumps PAExternal Website

Revision Effective Date: 07/01/2023

MODIFIERS:

  • Added: HCPCS codes J1811 and J1813 to the JK and JL modifier instructions to comply with the Inflation Reduction Act insulin coinsurance cap

CODING GUIDELINES:

  • Added: J1811 and J1813 to instruction for billing insulin administered through an external insulin pump (E0784)

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: HCPCS codes J1811 and J1813 to Group 1 Paragraph

06/22/2023: 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.

Intravenous Immune Globulin

LCD

Intravenous Immune Globulin LCDExternal Website

Revision Effective Date: 07/01/2023

HCPCS CODES:

  • Added: J1576

06/22/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Intravenous Immune Globulin PAExternal Website

Revision Effective Date: 07/01/2023

CODING GUIDELINES:

  • Added: Direction for billing Panzyga

06/22/2023: 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.

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