LCD and Policy Article Revisions
Summary for March 03, 2016
Outlined below are the principal changes to a 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, Bowel Management Devices, External Infusion Pumps, Immunosuppressive Drugs, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Parenteral Nutrition, Respiratory Assist Devices, Wheelchair Options/Accessories. Please review the entire LCD and related PA for complete information.
Ankle-Foot/Knee-Ankle-Foot Orthosis
LCD
Revision Effective Date: 01/01/2016:
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: L4361 "clerical correction"
HCPCS CODES:
Revised: L1902 and L1904 long narrative description
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
Moved: Repair/Replacement verbiage to correct location
Updated: Miscellaneous section when billing L2999
Policy Article
Revision Effective Date: 01/01/2016
CODING GUIDELINES:
Added: L4361 "clerical correction"
Bowel Management Devices
LCD
Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Replaced: Miscellaneous HCPCS Code A4335 with new code A4337
HCPCS CODES:
Added: HCPCS Code A4337
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language to remove start date verbiage from Prescription Requirements (Effective 11/05/2015)
Policy Article
Revision Effective Date: 01/01/2016
CODING GUIDELINES:
Replaced: Miscellaneous HCPCS Code A4335 with new code A4337
External Infusion Pumps
LCD
Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: HCPCS CODE J1575 to Subcutaneous immune globulin coverage
Added: HCPCS CODE J7340 to Levodopa-Carbidopa coverage
Added: HCPCS CODE J9039 to Blinatumomab coverage
Updated: HCPCS Code Q9977 crosswalked to J7999
HCPCS CODES:
Group 3 Codes:
Added: HCPCS Code J1575, J7340, J9039 (previously J7799)
Deleted: HCPCS Code Q9977
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Group 3 Codes:
Added: ICD-10 Code D83.1 to Group 3 Codes
Group 3 Paragraph:
Added: HCPCS Code J1575
Group 4 Paragraph:
Added: HCPCS Code J7340
Group 5 Paragraph:
Added: HCPCS Code J9039
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
Policy Article
Revision Effective Date: 01/01/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
CODING GUIDELINES:
Updated: HCPCS Code Q9977 cross-walked to J7999
Added: J1575, J7340, J9039 (previously J7799)
Updated: Billing instructions, by HCPCS code, based on dates of service
Immunosuppressive Drugs
LCD
Revision Effective Date: 01/01/2016
HCPCS CODES:
Added: J7503 and J7512
Updated: J7508 narrative
Deleted: J7506
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
Policy Article
Revision Effective Dates: 01/01/2016
CODING GUIDELINES:
Removed: J7506 from billing example, replaced with J7510
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
LCD
Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Updated: 3-drug regimen billing instructions
HCPCS CODES:
Added: HCPCS code J8655
Deleted: HCPCS code Q9978
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: J8655 to modifier billing instructions
Added: End date for HCPCS code Q9975
Added: Q0181 for billing rolapitant on or after 09/02/2015
KX, GA AND GZ MODIFIERS:
Added: Rolapitant (Q0181) to guidelines
Added: J8655 to guidelines
Policy Article
Revision Effective Date: 01/01/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Covered 3-drug combination regimen
CODING GUIDELINES:
Added: J8655
Added: End date of 12/31/2015 for Q9978
Added: Q0181 for billing rolapitant effective on or after 09/02/2015
Parenteral Nutrition
LCD
Revision Effective Date: 01/01/2016
HCPCS CODES:
Group 1 codes:
Updated: HCPCS Code B5000, B5100, B5200 narrative description
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language to remove start date verbiage from Prescription Requirements (Effective 11/05/2015)
Policy Article
Removed: Effective Date from Policy Article title
Respiratory Assist Devices
LCD
Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Replaced: HCPCS Codes E0450, E0460-E0464 with new HCPCS Codes E0465, E0466
DOCUMENTATION REQUIREMENTS
Revised: Standard Documentation language to remove start date verbiage from Prescription Requirements (Effective 11/05/2015)
Policy Article
Revision Effective Date: 11/05/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Standard Documentation language to remove start date verbiage from Prescription Requirements
Wheelchair Options/Accessories
LCD
Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: HCPCS code E1012 to Power Tilt and/or Recline Seating Systems range
HCPCS CODES:
Added: HCPCS code E1012
Revised: K0017 and K0018 long narrative description
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
Policy Article
Revision Effective Date: 01/01/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
CODING GUIDELINES:
Added: HCPCS code E1012
Added: HCPCS code E1012 to bundling table
Note: The information contained in this article is only a summary of revisions to the LCD and Policy Article. For complete information on any topic, you must review the LCD and/or Policy Article.
