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.
Lower Limb Prostheses
LCD
Revision Effective Date: 01/01/2010
INDICATIONS AND LIMITATIONS OF COVERAGE:
Added: Functional level requirement for L5973
HCPCS CODES:
Added: L5973
DOCUMENTATION REQUIREMENTS:
Deleted: Outdated instruction for code L5930
Policy Article
Revision Effective Date: 04/01/2010
CODING GUIDELINES:
Revised: Instructions for use of code L7520
Deleted: Instructions for use of RP modifier
Revised: Instructions for use of ultralight component codes L5940-L5960
Added: Statement concerning rejection of claims without an RT or LT modifier.
Oxygen and Oxygen Equipment
LCD
Revision Effective Date: 01/01/2010
HCPCS CODES AND MODIFIERS:
Added: E0433
Revised: E0441-E0444
Policy Article
Revision Effective Date: 01/01/2010
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Coverage for maintenance and servicing, months 37-60
CODING GUIDELINES:
Deleted: Instructions for codes E0441-E0444
Added: E0433
Patient Lifts
LCD
Revision Effective Date: 04/01/2010
INDICATIONS AND LIMITATIONS OF COVERAGE:
Added: E1036
HCPCS CODES AND MODIFIERS:
Revised: KX modifier
Added: GA and GZ modifiers.
Added: E1036 (effective 01/01/2010)
Revised: E1035
DOCUMENTATION REQUIREMENTS:
Added: KX modifier requirement for E1036.
Added: GA and GZ modifier instructions
Policy Article
Revision Effective Date: 01/01/2010
CODING GUIDELINES:
Added: E1036 to E1035 definition
Added: E1036 to list of codes that require PDAC coding review.
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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