LCD and Policy Article Revisions Summary for October 2009
 

October 8, 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.