February 4, 2010
LCD and Policy Article Revisions Summary for February 4, 2010
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.
External Infusion Pumps
LCD
Revision Effective Date: 04/01/2010
INDICATIONS AND LIMITATIONS OF COVERAGE:
- Revised: Physician assessment interval for insulin pumps from every 6 months to every 3 months
HCPCS CODES AND MODIFIERS:
- Added: GA and GZ modifiers
- Revised: KX modifier
DOCUMENTATION REQUIREMENTS:
- Removed: KX modifier requirement for supplies billed with external insulin infusion pumps and insulin.
- Revised: Requirements for use of KX modifier with external insulin infusion pumps and insulin to meet either the C-Peptide level criteria or beta cell autoantibody criterion.
- Added: Instructions for the use of GA and GZ modifiers.
- Added: Instructions for use of GY modifier from Policy article to LCD.
Facial Prosthesis
LCD
Revision Effective Date: 01/01/2010
HCPCS CODES AND MODIFIERS:
- Replaced: A4365 with A4456
Policy Article
Revision Effective Date: 01/01/2010
CODING GUIDELINES:
- Replaced: A4365 with A4456
Nebulizers
LCD
Revision Effective Date: 01/01/2010
INDICATIONS AND LIMITATIONS OF COVERAGE:
- Replaced: Q4080 with Q4074 in the Iloprost coverage indications
HCPCS CODES AND MODIFIERS:
- Replaced: Q4080 with Q4074
ICD-9 CODES:
- Replaced: Q4080 with Q4074 in the ICD-9 requirements
DOCUMENTATION REQUIREMENTS:
- Replaced: Q4080 with Q4074 in the KX, GA and GZ modifiers requirements
Policy Article
Revision Effective Date: 01/01/2010
CODING GUIDELINES:
- Replaced: Q4080 with Q4074 in the Inhalation Drug Requirements
Oral Anti-emetic Drugs
Policy Article
- Revision Effective Date: 01/01/2010
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Changed: Timing in criterion 4 to match IOM 100-02, Chapter 15, Section 50-5-4.
ICD-9 CODES THAT ARE COVERED:
- Deleted: V58.0-V58.12 and replaced with V58.11 to match IOM 100-02, Chapter 15, Section 50-5-4.
- Added: Requirement for Coding Verification Review effective 7/1/2010.
Spinal Orthosis
LCD
Revision Effective Date: 01/01/2010
HCPCS CODES AND MODIFIERS:
- Added: A4466
- Deleted: GY
DOCUMENTATION REQUIREMENTS:
- Deleted: Use of GY modifier with elastic spinal orthoses (Refer to Policy Article for coding guidelines for elastic and nonelastic spinal orthoses.)
Policy Article
Revision Effective Date: 01/01/2010
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Added: Revised code reference (A4466) for elastic spinal orthoses
CODING GUIDELINES:
- Added: Instructions for coding elastic and nonelastic flexible spinal orthoses
- Added: Requirement for Coding Verification Review effective 7/1/2010.
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.
