DME MAC A News for December 04, 2008 - LCD and Policy Article Revisions - Summary for December 2008

 

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December 04, 2008 LCD and Policy Article Revisions - Summary for December 2008Outlined below is a summary of the principal changes to several DME Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. Please review the entire LCD and each related Policy Article for complete information. External Infusion Pumps     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Added ICD-9 codes 249.00-249.91 to range for insulin pumps. (effective 10/01/2008)       Changes the physician assessment interval for insulin pumps from every 3 months to every 6 months.       Removed word "Subcutaneous" from paragraph describing use of epoprostenol/treprostinil.       Revised denial for pumps other than E0779 for administration of subcutaneous immune globulin to allow payment at least costly alternative.    HCPCS CODES AND MODIFIERS:       Narrative changes for codes J9000, J9040, J9100, J9110, J9190, J9200, and J9360.    ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:       Added ICD-9 codes 249.00-249.91 to range for insulin pumps. (effective 10/01/2008)     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Replaced SADMERC reference with PDAC. Glucose Monitors     LCD    Revision Effective Date: 10/01/2008    INDICATIONS AND LIMITATIONS OF COVERAGE:       Added: Delivery timeframe for shipping of refills.    ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:       Added: 249.00 - 249.91 ICD-9 diagnosis codes.     Policy Article    Revision Effective Date: 10/01/2008    CODING GUIDELINES:       Deleted: Moved ICD-9 code range to LCD.       Revised: Changed SADMERC to PDAC. Intravenous Immune Globulin     LCD    Revision Effective Date: 01/01/2009    HCPCS CODES AND MODIFIERS:       Added J1459.       Changed code descriptor for J1572.       Deleted Q4097.     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Replaced SADMERC reference with PDAC. Lower Limb Prostheses     LCD    Revision Effective Date: 01/01/2009    HCPCS CODES AND MODIFIERS:       Deleted: L5993 - L5995. Nebulizers     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Deleted: Least costly alternative statement for albuterol/ipratropium combination (J7620) scheduled to become effective November 1, 2008.       Revised: Statement about denial of coverage when more than one beta-adrenergic agent is provided.       Added: Maximum amount for albuterol/ipratropium combination.       Added: Delivery timeframe for shipping of refills.    HCPCS CODES AND MODIFIERS:       Added: Code J7606 (formoterol fumarate).       Deleted: Code Q4099 (formoterol fumarate).     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Deleted: References to trademarked name DuoNeb.       Revised: Changed SADMERC to PDAC. Ostomy Supplies     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Revised: Usual maximum quantity for A5083.     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Changed: References from SADMERC to PDAC.    ICD-9 CODES:       Added: 569.60  Oxygen and Oxygen Equipment     LCD    Revision Effective Date: 01/01/2009    HCPCS CODES AND MODIFIERS:       Added HCPCS Codes E1354, E1356, E1357, and E1358. Pneumatic Compression Devices     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Added: Statement regarding appliances for the chest and trunk.    HCPCS CODES AND MODIFIERS:       Added: E0656 and E0657.     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Changed: References from SADMERC to PDAC.       References from DMERC to DME MAC. Power Mobility Devices     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Changed: Terminology from Assistive Technology Supplier/Practitioner to Assistive Technology Professional.       Changed: References from SADMERC to PDAC.    HCPCS CODES AND MODIFIERS:       Revised: K0899    DOCUMENTATION REQUIREMENTS:       Revised: Guidance concerning the content of the face-to-face examination.     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Changed: References from SADMERC to PDAC. Pressure Reducing Support Surfaces - Group 2     LCD    Revision Effective Date: 01/01/2009    APPENDICES:       Revised: Definitions of pressure ulcer stages.    SOURCES OF INFORMATION AND BASIS FOR DECISION:       Added: Reference to NPUAP guidelines for pressure ulcer staging.     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Revised: Changed SADMERC to PDAC. Pressure Reducing Support Surfaces - Group 3     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Added : ICD-9 codes 707.23 and 707.24.    ICD-9 CODES:       Added: 707.23 & 707.24 - Pressure ulcers, stages III and IV.    APPENDICES:       Revised: Definitions of pressure ulcer stages.    SOURCES OF INFORMATION AND BASIS FOR DECISION:       Added: Reference to NPUAP guidelines for pressure ulcer staging.     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Revised: Changed SADMERC to PDAC. Surgical Dressings     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Added: Frequency of replacement for compression wrap (A6545).    HCPCS CODES AND MODIFIERS:       Added: A4490-A4510, A6545.       Revised: A6010-A6024, A6196-A6199, A6203-A6215, A6219-A6248, A6251-A6266, A6407.    APPENDICES:       Revised: Definitions of pressure ulcer stages.    SOURCES OF INFORMATION AND BASIS FOR DECISION:       Added: Reference to NPUAP guidelines for pressure ulcer staging.     Policy Article    Revision Effective Date: 01/01/2009    NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:       Clarified: Allowance for HCPCS codes which use the term "kit".       Added: Coverage statements for compression wraps (A6545).       Added: Noncoverage statement for surgical stockings (A4490-A4510).    CODING GUIDELINES:       Added: Requirement for PDAC Coding Verification Review for non-elastic compression wraps (A6545).       Revised: Changed SADMERC to PDAC. Therapeutic Shoes for Persons with Diabetes     Policy Article    Revision Effective Date: 10/01/2008    NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:       Added: Additional diagnosis codes for diabetes.    CODING GUIDELINES:       Replaced: References to SADMERC with PDAC.    ICD-9 CODES THAT ARE COVERED:       Added: 249.00-249.91. Wheelchair Seating     LCD    Revision Effective Date: 01/01/2009    INDICATIONS AND LIMITATIONS OF COVERAGE:       Replaced: Reference to SADMERC with PDAC.    HCPCS CODES AND MODIFIERS:       Added: E2231       Revised: K0669     Policy Article    Revision Effective Date: 01/01/2009    CODING GUIDELINES:       Revised: Guidelines for solid seat support base for manual wheelchair.       Replaced: References to SADMERC with PDAC. 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 article.

 

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