LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone Toll-free: 866.814.0192
Fax Toll-free: 866.818.0373
E-mail Address: orders at LEEDerGroup.com

2009-10 LCD and Policy Article Revisions - Summary for October 2009

LCD and Policy Article Revisions – Summary for October 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.

Ankle Foot/Knee Ankle Foot Orthosis LCD Revision Effective Date: 12/01/2009 HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers Deleted: GY modifier DOCUMENTATION REQUIREMENTS: Added: Instructions for the use of GA and GZ modifiers

Policy Article Revision Effective Date: 12/01/2009 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: Information on code A9283 CODING GUIDELINES: Revised: Instructions for coding A9283 Revised: Instructions for code L2770 Revised: Instructions for coding concentric adjustable torsion joints Revised: Instructions for RT/LT modifiers

Knee Orthosis LCD Revision Effective Date: 12/01/2009 HCPCS CODES AND MODIFIERS: Added: GA/GZ modifiers Revised: RT/LT descriptors DOCUMENTATION REQUIREMENTS: Added: Instructions for GA/GZ modifier use

Policy Article Revision Effective Date: 12/01/2009 CODING GUIDELINES: Revised: Instructions for code L2770 Revised: Instructions for coding concentric adjustable torsion joints Revised: Instructions for RT/LT modifiers

Nebulizers LCD Revision Effective Date: 12/01/2009 INDICATIONS AND LIMITATIONS OF COVERAGE: Added: Language from Program Integrity Manual on timing of refills and shipping of supplies/medications Revised: Coverage criteria for long-acting bronchodilators HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers Revised: KX modifier descriptor ICD-9 CODES: Revised: ICD-9 codes that support medical necessity for J7605, J7606 DOCUMENTATION: Deleted: KX requirements from J7605 & J7606 Added: Instructions for use of GA and GZ modifiers

Oral Anticancer Drugs Policy Article Revision Effective Date: 10/01/2009 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: 208.92-209.36, 209.70-209.79 to accepted diagnoses for busulfan, capecitabine, cyclophosphamide, etoposide, melphalan, methotrexate, or temozolomide CODING GUIDELINES: Changed: SADMERC to PDAC ICD-9 CODES THAT ARE COVERED: Added: 208.92-209.36, 209.70-209.79 to accepted diagnoses for busulfan, capecitabine, cyclophosphamide, etoposide, melphalan, methotrexate, or temozolomide

Oral Antiemetic Drugs LCD Revision Effective Date: 12/01/2009 HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers Revised: KX modifier DOCUMENTATION REQUIREMENTS: Added: Instructions for use of the GA and GZ modifiers

Policy Article Revision Effective Date: 10/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC ICD-9 CODES THAT ARE COVERED: Added: 208.92 – 209.36, 209.70-209.79

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.