September 03, 2009
- LCD and Policy Summary Article Revisions – Summary 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 LCD Revision Effective Date: 12/01/2009 INDICATIONS AND LIMITATIONS OF COVERAGE: Revised: Criteria for coverage of Group I Mattress. HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers. Revised: KX modifier. DOCUMENTATION REQUIREMENTS: Added: Instructions for the use of GA and GZ modifiers. APPENDICES: Revised: Definitions of pressure ulcer stages. SOURCES OF INFORMATION AND BASIS FOR DECISION: Added: Reference to NPUAP guidelines for pressure ulcer staging.
- Seat Lift Mechanisms Policy Article Revision Effective Date: 09/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC
- Speech Generating Devices LCD Revision Effective Date: 12/01/2009 HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers. Revised: KX modifier. DOCUMENTATION REQUIREMENTS: Added: Multicomponent instructions. Added: Instructions for the use of GA and GZ modifiers.
- Suction Pumps Policy Article Revision Effective Date: 09/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC.
- Surgical Dressings Policy Article Revision Effective Date: 01/01/2009 (September Publication) CODING GUIDELINES: Added: A6545 to list of codes requiring the AW modifier. Added: A6545 to list of codes requiring the RT and/or LT modifier(s). Revised: RT/LT modifier instructions.
- Therapeutic Shoes for Persons with Diabetes Policy Article Revision Effective Date: 09/01/2009 NON-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. 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 Supplies Policy Article Revision Effective Date: 09/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC.
- Transcutaneous Electrical Nerve Stimulators (TENS) LCD Revision Effective Date: 12/01/2009 INDICATIONS AND LIMITATIONS OF COVERAGE: Revised: Additional supply quantities denial statement. HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers. Revised: KX modifier. DOCUMENTATION REQUIREMENTS: Removed: Instructions for additional quantities. Added: Instructions for the use of GA and GZ modifiers.
- Urological Supplies LCD Revision Effective Date: 12/01/2009 INDICATIONS AND LIMITATIONS OF COVERAGE: Revised: Additional quantity denial statements for tape, anchoring devices and leg-bag straps. HCPCS CODES and MODIFIERS: Revised: KX modifier. DOCUMENTATION REQUIREMENTS: Added: Instructions for the use of the GY modifier. Removed: Instructions for additional quantities.
- Walkers LCD Revision Effective Date: 12/01/2009 HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers. Revised: KX modifier. DOCUMENTATION REQUIREMENTS: Added: Instructions for the use of GA and GZ modifiers.
- Wheelchair Seating LCD Revision Effective Date: 12/01/2009 INDICATIONS 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 cushions. Added: Above knee amputations, osteogenesis imperfecta, and transverse myelitis to the list of covered conditions for positioning seat and back cushions and positioning accessories. ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY: Added: Corresponding ICD-9 codes. HCPCS MODIFIERS: Added: GA, GZ DOCUMENTATION 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.