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April 9, 2026

LCD and Policy Article Revisions Summary for April 9, 2026

Joint DME MAC Publication

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 Ankle-Foot/Knee-Ankle-Foot Orthosis, Intravenous Immune Globulin, Knee Orthoses, Lower Limb Prostheses, Power Mobility Devices, Spinal Orthoses: TLSO and LSO, Urological Supplies, and Wheelchair Options/Accessories. Please review the entire LCDs and PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis

LCD

Ankle-Foot/Knee-Ankle-Foot Orthosis LCDExternal Website

Revision Effective Date: 04/01/2026

HCPCS CODES:

  • Added: L2221 to Group 1 Codes

04/09/2026: 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

Ankle-Foot/Knee-Ankle-Foot Orthosis PAExternal Website

Revision Effective Date: 04/01/2026

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary.” to “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of why the modifications are necessary and what modifications were performed at the time of fitting the orthosis to the beneficiary.,” as clarification

CODING GUIDELINES:

Added: Coding guideline information for L2221

04/09/2026: At this time 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: 04/01/2026

HCPCS CODES:

  • Added: J1553 to Group 1 Codes

04/09/2026: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to CMS HCPCS coding determinations.

PA

Intravenous Immune Globulin PAExternal Website

Revision Effective Date: 04/01/2026

CODING GUIDELINES:

  • Revised: “milligrams” to “mg” in directions for billing Panzyga, Yimmugo, and GAMMAGARD LIQUID ERC
  • Revised: “Claims for Yimmugo for dates of service on or after June 13, 2024 must be submitted using the HCPCS code J1599” to “Claims for Yimmugo for dates of service from June 13, 2024 to March 31, 2026 must be submitted using the HCPCS code J1599”
  • Added: Direction for billing Yimmugo using J1553, effective for dates of service on or after April 1, 2026
  • Added: Direction for billing Qivigy using J1599, effective for dates of service on or after September 26, 2025 (FDA Approval Date)

04/09/2026: 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.

Knee Orthoses

PA

Knee Orthoses PAExternal Website

Revision Effective Date: 01/25/2026

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary.” to “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of why the modifications are necessary and what modifications were performed at the time of fitting the orthosis to the beneficiary.,” as clarification
  • Revised: Custom fabricated language from “For custom fabricated orthoses” to “For a custom fabricated orthosis,” as clarification

04/09/2026: At this time 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.

Lower Limb Prostheses

LCD

Lower Limb Prostheses LCDExternal Website

Revision Effective Date: 04/01/2026

HCPCS CODES:

  • Added: L5992 to Group 1 Codes

04/09/2026: 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

Lower Limb Prostheses PAExternal Website

Revision Effective Date: 04/01/2026

CODING GUIDELINES:

  • Added: Coding guideline information for L5910, L5920, L5629, L5631, L5649, L5643, L5645, L5651, L5637, and L5650, as clarification
  • Revised: “For codes L5940, L5950, and L5960, the unit of service is per limb.” to “The unit of service for codes L5940, L5950, and L5960 is one per limb.” in the coding guideline information for L5940, L5950, and L5960, as clarification
  • Added: “The unit of service is one per limb.” to the coding guideline information for L5783, as clarification
  • Added: Coding guideline information for L5992

04/09/2026: At this time 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: 10/01/2025

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Information pertaining to the assistive technology professional assessment, including “The supplier ATP assessment date must be on or after the beginning of the face-to-face process with the treating practitioner and/or LCMP.,” as clarification

04/09/2026: At this time 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.

Spinal Orthoses: TLSO and LSO

PA

Spinal Orthoses: TLSO and LSO PAExternal Website

Revision Effective Date: 01/23/2024

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary.” to “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of why the modifications are necessary and what modifications were performed at the time of fitting the orthosis to the beneficiary.,” as clarification

04/09/2026: At this time 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: 04/01/2026

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Information pertaining to the reasonable and necessary quantity of female external urinary collection devices, to include the Tibbe Female External Urinary Device (A4318) quantity

SUMMARY OF EVIDENCE:

  • Removed: Summary of evidence information, due to not being applicable to the non-discretionary updates

ANALYSIS OF EVIDENCE (RATIONALE FOR DETERMINATION):

  • Removed: Analysis of evidence information, due to not being applicable to the non-discretionary updates

HCPCS CODES:

  • Added: A4318 to Group 1 Codes

BIBLIOGRAPHY:

  • Removed: Bibliography information, due to not being applicable to the non-discretionary updates

04/09/2026: 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

Urological Supplies PAExternal Website

Revision Effective Date: 04/01/2026

CODING GUIDELINES:

  • Added: “The Tibbe Female External Urinary Device (EUD) (A4318) is a device which is attached to the periurethral area with adhesive and which funnels urine into a closed collection system and can be used with either suction or gravity for drainage.”

04/09/2026: 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 Options/Accessories

PA

Wheelchair Options/Accessories PAExternal Website

Revision Effective Date: 10/01/2025

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Information pertaining to the assistive technology professional assessment, including “The supplier ATP assessment date must be on or after the beginning of the face-to-face process with the treating practitioner and/or licensed/certified medical professional (LCMP).,” as clarification

04/09/2026: At this time 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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