October 12, 2023
LCD and Policy Article Revisions Summary for October 12, 2023
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 Manual Wheelchair Bases, Power Mobility Devices, Urological Supplies, Wheelchair Options/Accessories, and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.
Manual Wheelchair Bases
PA
Revision Effective Date: 10/12/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: Information pertaining to the specialty evaluation
- Added: “If the supplier is owned by a hospital, the PT, OT, or practitioner working in the inpatient or outpatient hospital setting may perform the specialty evaluation.”
10/12/2023: 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.
Power Mobility Devices
PA
Revision Effective Date: 05/16/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: Information pertaining to the specialty evaluation
10/12/2023: 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.
Urological Supplies
LCD
Revision Effective Date: 10/01/2023
HCPCS CODES:
- Revised: Description of HCPCS code A4344 to “INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE OR POLYURETHANE, EACH”
10/12/2023: 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.
Wheelchair Options/Accessories
PA
Wheelchair Options/Accessories PA
Revision Effective Date: 10/12/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: Information pertaining to the specialty evaluation
- Added: “If the supplier is owned by a hospital, the PT, OT, or practitioner working in the inpatient or outpatient hospital setting may perform the specialty evaluation.”
10/12/2023: 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.
Wheelchair Seating
PA
Revision Effective Date: 10/12/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: Information pertaining to the specialty evaluation
- Added: “If the supplier is owned by a hospital, the PT, OT, or practitioner working in the inpatient or outpatient hospital setting may perform the specialty evaluation.”
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
- Added: “E0955” to Group 2 Paragraph and Group 3 Paragraph
- Added: Information pertaining to the diagnosis code requirements for E0955
ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
- Added: “Exception: For HCPCS code E0955, the ICD-10-CM codes specified in the preceding section are not an exhaustive list. See Group 2 and Group 3 in the preceding section, for additional information.” to Group 1 Paragraph
- Removed: “E0955” from language that noted “There are no specified ICD-10 codes”
10/12/2023: 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.