LCD and Policy Article Revisions Summary for May 19, 2016

Outlined below are the principal changes to a DME MAC Local Coverage Determination (LCD) and a Policy Article (PA) that has been revised and posted. The policy included is Knee Orthoses. Please review the entire LCD and related PA for complete information.

Knee Orthoses

LCD

Revision Effective Date: 06/02/2016

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: HCPCS Codes L1832 and L1833 to Group 2 Diagnoses

Added: Initial, Subsequent, and Sequela ICD-10s to Group 2 and Group 4

Removed: ICD-10 Non-specific femur codes S72.426B & S72.426C - entered in error

DOCUMENTATION REQUIREMENTS:

Revised: Standard Documentation language (Effective 04/28/2016) ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: HCPCS Codes L1832 and L1833 to Group 2 Diagnoses

Added: Initial, Subsequent, and Sequela ICD-10s to Group 2 and Group 4

Removed: ICD-10 Non-specific femur codes S72.426B & S72.426C - entered in error

DOCUMENTATION REQUIREMENTS:

Revised: Standard Documentation language (Effective 04/28/2016)

Policy Article

Revision Effective Date: 06/02/2016

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: Definitions from CMS DMEPOS Quality Standards (42 CFR 424.57) and 42 CFR 414.402

CODING GUIDELINES:

Added: Custom fabricated orthosis definitions

Added: Definition of K0672

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