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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

Manual Wheelchair Bases PAExternal Website

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

Power Mobility Devices PAExternal Website

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

Urological Supplies LCDExternal Website

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 PAExternal Website

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

Wheelchair Seating PAExternal Website

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.

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