LCD and Policy Article Revisions Summary

 

LCD and Policy Article Revisions Summary for March 27, 2014

Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCDs) and a Policy Articles (PA) that have been revised and posted. Please review the entire LCD and each related PA for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis

LCD
Revision Effective Date: 01/01/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: References to off-the-shelf (OTS) and custom fitted
Added: New and revised 2014 HCPCS codes to coverage statements
Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables
HCPCS CODES AND MODIFIERS:
Added: L4361, L4387, L4397
For the following codes, the descriptor was changed: L1902, L1904, L1906, L1907, L4350, L4360, L4370, L4386, L4396, L4398
DOCUMENTATION REQUIREMENTS:
Added: Documentation requirement for custom fitted vs. OTS

Policy Article
Revision Effective Date: 01/01/2014
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Correct coding statement for prefabricated orthoses
Added: Denial statement for incorrect coding
CODING GUIDELINES:
Added: Definitions of off-the-shelf and custom fitted
Added: Respective off-the-shelf and custom fitted codes to coding statements
Added: Definitions for minimal self-adjustment, substantial modification and kits

Knee Orthoses

LCD
Revision Effective Date: 01/01/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: References to off-the-shelf (OTS) and custom fitted
Added: HCPCS codes for OTS and custom fitted to their respective coverage statements, including correct coding statement for custom fitted items
Added: HCPCS codes to the Tables for Addition Codes-Eligible for Separate Payment, and Not Reasonable and Necessary
Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables
HCPCS CODES AND MODIFIERS:
Added: L1812, L1833, L1848
For the following codes, the descriptor was changed: L1810, L1830, L1832, L1836, L1843, L1845, L1847, L1850
DOCUMENTATION REQUIREMENTS:
Added: Documentation requirement for custom fitted vs. OTS

Policy Article
Revision Effective Date: 01/01/2014
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Correct coding statement for prefabricated orthoses
Added: Denial statement for incorrect coding
Added: L1812 and L1833 to the reasonable useful lifetime table
CODING GUIDELINES:
Added: Definitions for off-the-shelf and custom fitted
Added: Definitions for minimal self-adjustment, substantial modification and kits
Added: L1812, L1833, L1848 base codes and the not separately payable codes to the table

Oral Anticancer Drugs

Policy Article
Revision Effective Date: 03/01/2014
ICD-9 CODES THAT ARE COVERED:
Deleted: ICD-9 diagnosis code V23.89. Inadvertent addition of an inappropriate ICD-9-CM code

Pneumatic Compression Devices

LCD
Revision Effective Date: 07/01/2013
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: Information that item(s) in policy are subject to ACA 6407 requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: ACA 6407 information

Policy Article
Revision Effective Date: 07/01/2013
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 information

Spinal Orthoses: TLSO and LSO

LCD
Revision Effective Date: 01/01/2014
COVERAGE INDICATIONS, LIMITATIONS, and/or MEDICAL NECESSITY:
Added: References to off-the-shelf (OTS) and custom fitted
Added: HCPCS codes for OTS and custom fitted to their respective coverage statements, including correct coding statement for custom fitted items
HCPCS CODES AND MODIFIERS:
Added: L0455, L0457, L0467, L0469, L0623, L0641, L0642, L0643, L0648, L0649, L0650 and L0651
Revised: HCPCS Narrative of L0450, L0454, L0456, L0460, L0466, L0468, L0621, L0625, L0626, L0627, L0628, L0630, L0631, L0633, L0637, L0639 and L0984
DOCUMENTATION REQUIREMENTS:
Added: Documentation requirement for custom fitted vs. OTS

Policy Article
Revision Effective Date: 01/01/2014
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Correct coding statement for prefabricated orthoses
CODING GUIDELINES:
Added: Definitions for off-the-shelf and custom fitted
Added: Definitions for minimal self-adjustment, substantial modification and kits

Note: The information contained in this article is only a summary of revisions to LCDs and Policy Articles. For complete information on any topic, you must review the LCD and/or Policy Article.

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