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Cervical Traction Devices - Policy Article

Article A52476 · 9 versions, 2015 to today · last changed 2020-01-01 (R8)

Version 27 of Article A52476: in force by CMS's dates 2020-01-01 onward. The policy text on this page comes from this archived version.

DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
source

CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.

CMS's newest revision note (R8, 2020-01-01), quoted

Revision Effective Date: 01/01/2020 REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 FED. REG VOL 217): Removed: “The link will be located here once it is available.” Added: “The required Face-to-Face Encounter and Written Order Prior to Delivery List is available here.” with a hyperlink to the list 04/14/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
source

This quote comes from CMS's revision-history file, not from the version's own file: Our archived file.

Sections in this version: Article Text. Plus 4 sections marked N/A in this version.

ICD-10-CM Codes that Support Medical Necessity (CMS lists no codes)

Group 1: CMS lists no codes in this group

CMS published no paragraph for this group.

ICD-10-CM Codes that DO NOT Support Medical Necessity (CMS lists no codes)

Group 1: CMS lists no codes in this group

CMS published no paragraph for this group.

CMS's list for version 27. The full code table serves customers with an API key.

source

CMS's ICD-10-CM lists in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.

Full verbatim text serves to customers · Customer? Log in

Version history, Article A52476

CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.

Revision history, every version

CMS's own change log, quoted, 8 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.

R8 · 2020-01-01 · v27
Revision Effective Date: 01/01/2020
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 FED. REG VOL 217):
Removed: “The link will be located here once it is available.”
Added: “The required Face-to-Face Encounter and Written Order Prior to Delivery List is available here.” with a hyperlink to the list


04/14/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R7 · 2020-01-01 · v25
Revision Effective Date: 01/01/2020
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):
Removed: Due to Final Rule 1713
 REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):
 Added: Section information based on Final Rule 1713
 ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
 Revised: Section header “ICD-10 Codes that are Covered” updated to “ICD-10 Codes that Support Medical Necessity”
 ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
 Revised: Section header “ICD-10 Codes that are Not Covered” updated to “ICD-10 Codes that DO NOT Support Medical Necessity”


02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R6 · 2019-01-01 · v20
Revision Effective Date: 01/01/2019
 CODING GUIDELINES:
 Added: Coding guidelines for E0856


01/31/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R5 · 2017-01-01 · v15
Revision Effective Date: 01/01/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Added: 42 CFR 410.38(g) language, previously in Policy specific Documentation Requirement section.


04/05/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
R4 · 2017-01-01 · v13
Revision Effective Date: 01/01/2017
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: 42 CFR 410.38(g) and Modifiers requirements
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements Language Article
R3 · 2016-07-01 · v10
Revision Effective Date: 07/01/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised Standard Language to add Statutory Prescription (Order) Requirements, revised Face to Face and ACA requirements (Effective 04/28/2016)
R2 · 2016-07-01 · v7
Effective July 1, 2016 oversight for DME MAC Articles is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the Articles.
R1 · 2015-10-01 · v4
Revision Effective Date: 10/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: HCPCS E0856 Narrative in ACA table
Removed: "When required by state law" from ACA new prescription requirements
Receipts for auditors

Version 27 of Article A52476, shown on this page: in force by CMS's dates 2020-01-01 onward. Archived 2026-09-26. CMS's copy · Our archived file. 5 of 5 sections are proven word-identical to the archived file.

Every archived version of Article A52476 (9 versions, CMS's dates, window by the as-of rule).

DocumentVersionIn forceArchived onVerify
Article A52476version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
Article A52476version 42015-10-01 to 2016-06-302026-09-26CMS's copy · Our archived file
Article A52476version 72016-07-01, superseded same day2026-09-26CMS's copy · Our archived file
Article A52476version 102016-07-01 to 2016-12-312026-09-26CMS's copy · Our archived file
Article A52476version 132017-01-01, superseded same day2026-09-26CMS's copy · Our archived file
Article A52476version 152017-01-01 to 2018-12-312026-09-26CMS's copy · Our archived file
Article A52476version 202019-01-01 to 2019-12-312026-09-26CMS's copy · Our archived file
Article A52476version 252020-01-01, superseded same day2026-10-09CMS's copy · Our archived file
Article A52476version 27 shown2020-01-01 to today2026-09-26CMS's copy · Our archived file

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Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.