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March 21, 2024

Policy Article Revisions Summary for March 21, 2024

Joint DME MAC Publication

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Eye Prostheses, Facial Prostheses and Oxygen and Oxygen Equipment. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Eye Prostheses

PA

Eye Prostheses PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES

  • Removed: "Claims for eye prostheses from nonphysicians provided in an office or nursing home setting are submitted to the DME MAC. Claims for eye prostheses from physicians in these settings are submitted to the applicable A/B MAC."
  • Added: "Physicians who are enrolled as a DMEPOS supplier are to submit claims for eye prostheses provided in an office or nursing home setting by nonphysicians or physicians to the DME MAC."

MODIFIERS

  • Added: "MODIFIERS" section and right (RT) and/or left (LT) modifier information

CODING GUIDELINES

  • Removed: Right (RT) and/or left (LT) modifier information

03/21/2024: 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.

Facial Prostheses

PA

Facial Prostheses PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES

  • Removed: "Claims for facial prostheses from nonphysicians provided in an office or nursing home setting are submitted to the DME MAC. Claims for facial prostheses from physicians in these settings are submitted to the local carrier."
  • Added: "Physicians who are enrolled as a DMEPOS supplier are to submit claims for eye prostheses provided in an office or nursing home setting by nonphysicians or physicians to the DME MAC."
  • Revised: "local intermediary" to "applicable A/B MAC"
  • Removed: "Implanted prosthesis anchoring components should not be billed to the DME MAC." due to redundancy

03/21/2024: 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.

Oxygen and Oxygen Equipment

PA

Oxygen and Oxygen Equipment PAExternal Website

Revision Effective Date: 04/01/2023

CODING INFORMATION:

  • Added: "For all claims submitted with the N3 modifier." to Group 1 Paragraph for ICD-10 Codes that DO NOT Support Medical Necessity
  • Added: ICD-10 codes J96.01, J96.11, J96.21, J96.91, R09.02 to Group 1 ICD-10-CM Codes that DO NOT Support Medical Necessity

03/21/2024: 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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