Jurisdiction B News: LCD and Policy Article Revisions Summary for September 2009

 

LCD and Policy Article RevisionsSummary for September 2009 Outlined below are the principal changes to several DME MAC 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. Pressure Reducing Support Surfaces - Group 1 LCDRevision Effective Date: 12/01/2009 INDICATIONS AND LIMITATIONS OF COVERAGE:  Revised: Criteria for coverage of Group I Mattress HCPCS CODES:Added: GA and GZ modifiersRevised: KX modifierDOCUMENTATION REQUIREMENTS:Added: Instructions for the use of GA and GZ modifiersAPPENDICES:  Revised: Definitions of pressure ulcer stages SOURCES OF INFORMATION AND BASIS FOR DECISION:  Added: Reference to NPUAP guidelines for pressure ulcer staging Policy ArticleRevision Effective Date: 12/01/2009CODING GUIDELINES:Changed: SADMERC to PDAC Seat Lift MechanismsPolicy ArticleRevision Effective Date: 09/01/2009 CODING GUIDELINES:  Changed: SADMERC to PDAC Speech Generating Devices LCDRevision Effective Date: 12/01/2009HCPCS CODES AND MODIFIERS:Added: GA and GZ modifiersRevised: KX modifierDOCUMENTATION REQUIREMENTS:Added: Multicomponent instructionsAdded: Instructions for the use of GA and GZ modifiers Policy ArticleRevision Effective Date: 12/01/2009 CODING GUIDELINES:  Changed: SADMERC to PDAC Suction PumpsPolicy ArticleRevision Effective Date: 09/01/2009 CODING GUIDELINES:  Changed: SADMERC to PDAC Surgical DressingsPolicy ArticleRevision Effective Date: 01/01/2009 (September 2009 Publication)CODING GUIDELINES:Added: A6545 to list of codes requiring the AW modifierAdded: A6545 to list of codes requiring the RT and/or LT modifier(s)Revised: RT/LT modifier instructions Therapeutic Shoes for Persons with DiabetesPolicy ArticleRevision Effective Date: 09/01/2009NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:Clarified:  Documentation of qualifying conditions must be in the medical records of the certifying physician.  (This requirement has always been included in the national policy.  The 09/1/09 effective date does not apply.)  CODING GUIDELINES: Revised:  Billing instructions for the RT and LT modifiers.Revised:  Statement concerning which products billed with code A5513 must have PDAC Coding Verification Review. Tracheostomy Care SuppliesPolicy ArticleRevision Effective Date: 09/01/2009CODING GUIDELINES:Changed: SADMERC to PDAC Transcutaneous Electrical Nerve Stimulation (TENS)LCDRevision Effective Date: 12/01/2009INDICATIONS AND LIMITATIONS OF COVERAGE:Revised: Additional supply quantities denial statementHCPCS CODES AND MODIFIERS:Added: GA and GZ modifiersRevised: KX modifierDOCUMENTATION REQUIREMENTS:Removed: Instructions for additional quantitiesAdded: Instructions for the use of GA and GZ modifiers Policy ArticleRevision Effective Date: 12/01/2009 CODING GUIDELINES:  Changed: SADMERC to PDAC Urological SuppliesLCDRevision Effective Date: 12/01/2009INDICATIONS AND LIMITATIONS OF COVERAGE:Revised: Additional quantity denial statements for tape, anchoring devices and leg-bag straps HCPCS CODES and MODIFIERS:Revised: KX modifierDOCUMENTATION REQUIREMENTS:Added: Instructions for the use of the GY modifierRemoved: Instructions for additional quantities Policy ArticleRevision Effective Date: 12/01/2009 CODING GUIDELINES:Clarified: A4353 Changed: SADMERC to PDAC WalkersLCDRevision Effective Date: 12/01/2009 HCPCS CODES AND MODIFIERS:Added: GA and GZ modifiersRevised: KX modifierDOCUMENTATION REQUIREMENTS:Added: Instructions for the use of GA and GZ modifiers Policy ArticleRevision Effective Date: 11/09/2009 CODING GUIDELINES:  Changed: SADMERC to PDAC Wheelchair SeatingLCDRevision Effective Date: 12/01/2009INDICATIONS AND LIMITATIONS OF COVERAGE:  Added: Hemiplegia, Huntington s chorea, idiopathic torsion dystonia, and cerebral palsy to the list of covered conditions for skin protection seat cushionsAdded:  Above knee amputations, osteogenesis imperfecta, and transverse myelitis to the list of covered conditions for positioning seat and back cushions and positioning accessoriesICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:Added: Corresponding ICD-9 codesMoved: 359.0, 359.1 from second group of codes to the first group of codes for E2607, E2608, K0736, K0737 HCPCS MODIFIERS:  Added: GA, GZRevised: KX modifierDOCUMENTATION REQUIREMENTS:  Added: Instructions for use of GA and GZ modifiers 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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