Coverage Knowledge Base
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Oral Anticancer Drugs - Policy Article
Article A52479 · 33 versions, 2015 to today · last changed 2026-10-01 (R19)
Version 76 of Article A52479: in force by CMS's dates 2026-10-01 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 (R19, 2026-10-01), quoted
Revision Effective Date: 10/01/2026 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM code C79.83 to Group 6 Codes, due to ICD-10-CM code updates 10/01/2026: 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 (4520 codes)
Group 1: 498 codes. CMS's group paragraph, quoted
The presence of an ICD-10 code listed in this section is not sufficient by itself to assure coverage. Refer to the Non-Medical Necessity Coverage and Payment Rules section for other coverage criteria and payment information.
For Busulfan:
Group 2: 280 codes. CMS's group paragraph, quoted
For Capecitabine:
Group 3: 990 codes. CMS's group paragraph, quoted
For Cyclophosphamide:
Group 4: 846 codes. CMS's group paragraph, quoted
For Etoposide:
Group 5: 384 codes. CMS's group paragraph, quoted
For Melphalan:
Group 6: 890 codes. CMS's group paragraph, quoted
For Methotrexate:
Group 7: 264 codes. CMS's group paragraph, quoted
For Temozolomide:
Group 8: 368 codes. CMS's group paragraph, quoted
For Topotecan:
ICD-10-CM Codes that DO NOT Support Medical Necessity (CMS lists no codes)
Group 1: CMS lists no codes in this group. CMS's group paragraph, quoted
All codes not listed in the previous section.
CMS's list for version 76. 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 A52479
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.
v22015-10-01, superseded same dayv22015-10-01 to 2016-06-30v32016-07-01, superseded same dayv32016-07-01, superseded same dayv62016-07-01, superseded same dayv62016-07-01 to 2016-09-30v132016-10-01, superseded same dayv132016-10-01 to 2016-12-31v192017-01-01, superseded same dayv192017-01-01 to 2017-09-30v242017-10-01, superseded same dayv242017-10-01 to 2018-09-30v312018-10-01, superseded same dayv312018-10-01, superseded same dayv332018-10-01, superseded same dayv332018-10-01 to 2019-07-31v352019-08-01, superseded same dayv352019-08-01 to 2019-12-31v392020-01-01, superseded same dayv392020-01-01 to 2021-09-30v422021-10-01, superseded same dayv422021-10-01, superseded same dayv442021-10-01, superseded same dayv442021-10-01 to 2022-09-30v492022-10-01, superseded same dayv492022-10-01 to 2023-07-05v532023-07-06, superseded same dayv532023-07-06 to 2023-09-30v592023-10-01, superseded same dayv592023-10-01 to 2024-09-30v642024-10-01 to 2025-09-30v732026-01-01 to 2026-09-30v762026-10-01 to today
Revision history, every version
CMS's own change log, quoted, 31 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.
R19 · 2026-10-01 · v76
Revision Effective Date: 10/01/2026 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM code C79.83 to Group 6 Codes, due to ICD-10-CM code updates 10/01/2026: 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.
R18 · 2026-01-01 · v73
Revision Effective Date: 01/01/2026 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: Group 5 Paragraph for Fludarabine Phosphate Removed: Group 5 Codes Revised : Subsequent groups re-numbered due to Group 5 removal 01/08/2026: 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.
R15 · 2024-10-01 · v64
Revision Effective Date: 10/01/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10-CM codes C83.39, C86.0, C86.1, C86.2, C86.3, C86.4, C86.5, C86.6, C88.2, C88.3, C88.4, C88.8, C88.9 from Group 1 and Group 4, due to ICD-10-CM code updates Removed: ICD-10-CM code E34.0 from Group 2, due to ICD-10-CM code updates Removed: ICD-10-CM codes C83.39, C86.0, C86.1, C86.2, C86.3, C86.4, C86.5, C86.6, C88.0, C88.2, C88.3, C88.4, C88.8, C88.9 from Group 3, due to ICD-10-CM code updates Removed: ICD-10-CM codes C83.39, C86.0, C86.1, C86.2, C86.3, C86.4, C86.5, C86.6, C88.0, C88.4 from Group 5, due to ICD-10-CM code updates Removed: ICD-10-CM codes C88.0, C88.2, C88.3, C88.8, C88.9 from Group 6, due to ICD-10-CM code updates Removed: ICD-10-CM codes C83.39, C86.0, C86.1, C86.2, C86.3, C86.4, C86.5, C86.6, C88.4 from Group 7, due to ICD-10-CM code updates Removed: ICD-10-CM codes C83.39, E34.0 from Group 8, due to ICD-10-CM code updates Removed: ICD-10-CM codes C83.39, C88.2, C88.3, C88.8, C88.9 from Group 9, due to ICD-10-CM code updates Removed: ICD-10-CM codes E08.649, E16.0, E16.1, E16.3 from Group 2 and Group 8 Added: ICD-10-CM codes C81.00, C81.01, C81.02, C81.03, C81.04, C81.05, C81.06, C81.07, C81.08, C81.09, C81.0A, C81.10, C81.11, C81.12, C81.13, C81.14, C81.15, C81.16, C81.17, C81.18, C81.19, C81.1A, C81.20, C81.21, C81.22, C81.23, C81.24, C81.25, C81.26, C81.27, C81.28, C81.29, C81.2A, C81.30, C81.31, C81.32, C81.33, C81.34, C81.35, C81.36, C81.37, C81.38, C81.39, C81.3A, C81.40, C81.41, C81.42, C81.43, C81.44, C81.45, C81.46, C81.47, C81.48, C81.49, C81.4A, C81.70, C81.71, C81.72, C81.73, C81.74, C81.75, C81.76, C81.77, C81.78, C81.79, C81.7A, C81.90, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99, C81.9A, C82.0A, C82.1A, C82.2A, C82.3A, C82.4A, C82.5A, C82.6A, C82.8A, C82.9A, C83.0A, C83.1A, C83.390, C83.398, C83.3A, C83.5A, C83.7A, C83.8A, C83.9A, C84.0A, C84.1A, C84.4A, C84.6A, C84.7B, C84.9A, C84.AA, C84.ZA, C85.1A, C85.2A, C85.8A, C85.9A, C86.00, C86.01, C86.10, C86.11, C86.20, C86.21, C86.30, C86.31, C86.40, C86.41, C86.50, C86.51, C86.60, C86.61, C88.20, C88.21, C88.30, C88.31, C88.40, C88.41, C88.80, C88.81, C88.90, C88.91 to Group 1, due to ICD-10-CM code updates Added: ICD-10-CM codes E34.00, E34.01, E34.09 to Group 2, due to ICD-10-CM code updates Added: ICD-10-CM codes C81.0A, C81.1A, C81.2A, C81.3A, C81.4A, C81.7A, C81.9A, C82.0A, C82.1A, C82.2A, C82.3A, C82.4A, C82.5A, C82.6A, C82.8A, C82.9A, C83.0A, C83.1A, C83.390, C83.398, C83.3A, C83.5A, C83.7A, C83.8A, C83.9A, C84.0A, C84.1A, C84.4A, C84.6A, C84.7B, C84.9A, C84.AA, C84.ZA, C85.1A, C85.2A, C85.8A, C85.9A, C86.00, C86.01, C86.10, C86.11, C86.20, C86.21, C86.30, C86.31, C86.40, C86.41, C86.50, C86.51, C86.60, C86.61, C88.00, C88.01, C88.20, C88.21, C88.30, C88.31, C88.40, C88.41, C88.80, C88.81, C88.90, C88.91 to Group 3, due to ICD-10-CM code updates Added: ICD-10-CM codes C81.0A, C81.1A, C81.2A, C81.3A, C81.4A, C81.7A, C81.9A, C82.0A, C82.1A, C82.2A, C82.3A, C82.4A, C82.5A, C82.6A, C82.8A, C82.9A, C83.0A, C83.1A, C83.390, C83.398, C83.3A, C83.5A, C83.7A, C83.8A, C83.9A, C84.0A, C84.1A, C84.4A, C84.6A, C84.7B, C84.9A, C84.AA, C84.ZA, C85.1A, C85.2A, C85.8A, C85.9A, C86.00, C86.01, C86.10, C86.11, C86.20, C86.21, C86.30, C86.31, C86.40, C86.41, C86.50, C86.51, C86.60, C86.61, C88.20, C88.21, C88.30, C88.31, C88.40, C88.41, C88.80, C88.81, C88.90, C88.91 to Group 4, due to ICD-10-CM code updates Added: ICD-10-CM codes C81.0A, C81.1A, C81.2A, C81.3A, C81.4A, C81.7A, C81.9A, C82.0A, C82.1A, C82.2A, C82.3A, C82.4A, C82.5A, C82.6A, C82.8A, C82.9A, C83.0A, C83.1A, C83.390, C83.398, C83.3A, C83.5A, C83.7A, C83.8A, C83.9A, C84.0A, C84.1A, C84.4A, C84.6A, C84.7B, C84.9A, C84.AA, C84.ZA, C85.1A, C85.2A, C85.8A, C85.9A, C86.00, C86.01, C86.10, C86.11, C86.20, C86.21, C86.30, C86.31, C86.40, C86.41, C86.50, C86.51, C86.60, C86.61, C88.00, C88.01, C88.40, C88.41 to Group 5, due to ICD-10-CM code updates Added: ICD-10-CM codes C81.0A, C81.1A, C81.2A, C81.3A, C81.4A, C81.7A, C81.9A, C88.00, C88.01, C88.20, C88.21, C88.30, C88.31, C88.80, C88.81, C88.90, C88.91 to Group 6, due to ICD-10-CM code updates Added: ICD-10-CM codes C81.0A, C81.1A, C81.2A, C81.3A, C81.4A, C81.7A, C81.9A, C82.0A, C82.1A, C82.2A, C82.3A, C82.4A, C82.5A, C82.6A, C82.8A, C82.9A, C83.0A, C83.1A, C83.390, C83.398, C83.3A, C83.5A, C83.7A, C83.8A, C83.9A, C84.0A, C84.1A, C84.4A, C84.6A, C84.7B, C84.9A, C84.AA, C84.ZA, C85.1A, C85.2A, C85.8A, C85.9A, C86.00, C86.01, C86.10, C86.11, C86.20, C86.21, C86.30, C86.31, C86.40, C86.41, C86.50, C86.51, C86.60, C86.61, C88.40, C88.41 to Group 7, due to ICD-10-CM code updates Added: ICD-10-CM codes C83.8A, C84.0A, C84.1A, C83.390, C83.398, E34.00, E34.01, E34.09 to Group 8, due to ICD-10-CM code updates Added: ICD-10-CM codes C83.8A, C83.390, C83.398, C88.20, C88.21, C88.30, C88.31, C88.80, C88.81, C88.90, C88.91 to Group 9, due to ICD-10-CM code updates 09/12/2024: 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.
R14 · 2023-10-01 · v59
Revision Effective Date: 10/01/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10-CM code D48.1 from Group 7 Codes due to ICD-10-CM code updates Added: ICD-10-CM codes D48.110, D48.111, D48.112, D48.113, D48.114, D48.115, D48.116, D48.117, D48.118, D48.119, D48.19 to Group 7 Codes due to ICD-10-CM code updates 09/21/2023: 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.
R14 · 2023-10-01 · v59
Revision Effective Date: 10/01/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10-CM code D48.1 from Group 7 Codes due to ICD-10-CM code updates Added: ICD-10-CM codes D48.110, D48.111, D48.112, D48.113, D48.114, D48.115, D48.116, D48.117, D48.118, D48.119, D48.19 to Group 7 Codes due to ICD-10-CM code updates 09/21/2023: 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.
R13 · 2023-07-06 · v53
Revision Effective Date: 07/06/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10 codes C7A.00, C7A.010, C7A.011, C7A.012, C7A.019, C7A.020, C7A.021, C7A.022, C7A.023, C7A.024, C7A.025, C7A.026, C7A.029, C7A.091, C7A.092, C7A.093, C7A.094, C7A.095, C7A.096, C7A.098, C7A.1, C7A.8, C7B.8, E34.0, Z85.020, Z85.030, Z85.040, Z85.060, Z85.230 to Group 2 Codes Added: ICD-10 codes C75.5, C7B.8 to Group 3 Codes Added: ICD-10 codes C74.10, C74.11, C74.12, C74.90, C74.91, C74.92, C75.5, C7A.00, C7A.010, C7A.011, C7A.012, C7A.019, C7A.020, C7A.021, C7A.022, C7A.023, C7A.024, C7A.025, C7A.026, C7A.029, C7A.091, C7A.092, C7A.093, C7A.094, C7A.095, C7A.096, C7A.098, C7A.8, C7B.8, E34.0, Z85.020, Z85.030, Z85.040, Z85.060, Z85.110, Z85.230 to Group 8 Codes 07/06/2023: 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.
R13 · 2023-07-06 · v53
Revision Effective Date: 07/06/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10 codes C7A.00, C7A.010, C7A.011, C7A.012, C7A.019, C7A.020, C7A.021, C7A.022, C7A.023, C7A.024, C7A.025, C7A.026, C7A.029, C7A.091, C7A.092, C7A.093, C7A.094, C7A.095, C7A.096, C7A.098, C7A.1, C7A.8, C7B.8, E34.0, Z85.020, Z85.030, Z85.040, Z85.060, Z85.230 to Group 2 Codes Added: ICD-10 codes C75.5, C7B.8 to Group 3 Codes Added: ICD-10 codes C74.10, C74.11, C74.12, C74.90, C74.91, C74.92, C75.5, C7A.00, C7A.010, C7A.011, C7A.012, C7A.019, C7A.020, C7A.021, C7A.022, C7A.023, C7A.024, C7A.025, C7A.026, C7A.029, C7A.091, C7A.092, C7A.093, C7A.094, C7A.095, C7A.096, C7A.098, C7A.8, C7B.8, E34.0, Z85.020, Z85.030, Z85.040, Z85.060, Z85.110, Z85.230 to Group 8 Codes 07/06/2023: 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.
R12 · 2022-10-01 · v49
Revision Effective Date: 10/01/2022 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Revised: ICD-10-CM code descriptor for C84.40, C84.41, C84.42, C84.43, C84.44, C84.45, C84.46, C84.47, C84.48, C84.49 in Groups 1, 3, 4, 5, 7 Codes due to ICD-10-CM code updates 09/22/2022: 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.
R12 · 2022-10-01 · v49
Revision Effective Date: 10/01/2022 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Revised: ICD-10-CM code descriptor for C84.40, C84.41, C84.42, C84.43, C84.44, C84.45, C84.46, C84.47, C84.48, C84.49 in Groups 1, 3, 4, 5, 7 Codes due to ICD-10-CM code updates 09/22/2022: 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.
R11 · 2021-10-01 · v44
Revision Effective Date: 10/01/2021 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.
R11 · 2021-10-01 · v44
Revision Effective Date: 10/01/2021 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.
R10 · 2021-10-01 · v42
Revision Effective Date: 10/01/2021 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM C56.3 to groups 1, 2, 3, 4, 6, 7, 9, ICD-10-CM C79.63 to groups 2, 3, 4, 6, 7, 8, 9, ICD-10-CM C84.7A to groups 1, 3, 4, 5, 7 due to annual ICD-10-CM code updates 10/07/2021: 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.
R10 · 2021-10-01 · v42
Revision Effective Date: 10/01/2021 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM C56.3 to groups 1, 2, 3, 4, 6, 7, 9, ICD-10-CM C79.63 to groups 2, 3, 4, 6, 7, 8, 9, ICD-10-CM C84.7A to groups 1, 3, 4, 5, 7 due to annual ICD-10-CM code updates 10/07/2021: 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.
R9 · 2020-01-01 · v39
Revision Effective Date: 01/01/2020 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Removed: Statement “Covered ICD-10 Codes” Added: “ICD-10 codes that Support Medical Necessity” REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217): Added: Section and related information based on Final Rule 1713 MODIFIERS: Removed: EY modifier information, now incorporation into Standard Documentation Requirements 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” 02/13 /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.
R9 · 2020-01-01 · v39
Revision Effective Date: 01/01/2020 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Removed: Statement “Covered ICD-10 Codes” Added: “ICD-10 codes that Support Medical Necessity” REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217): Added: Section and related information based on Final Rule 1713 MODIFIERS: Removed: EY modifier information, now incorporation into Standard Documentation Requirements 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” 02/13 /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.
R8 · 2019-08-01 · v35
Revision Effective Date: 08/01/2019 ICD-10 CODES THAT ARE COVERED: Added: ICD-10 Code C7A.1 to Group 8 diagnosis codes 06/13/2019: 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.
R8 · 2019-08-01 · v35
Revision Effective Date: 08/01/2019 ICD-10 CODES THAT ARE COVERED: Added: ICD-10 Code C7A.1 to Group 8 diagnosis codes 06/13/2019: 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.
R7 · 2018-10-01 · v33
02/07/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This is an article and not a local coverage determination.
R7 · 2018-10-01 · v33
02/07/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This is an article and not a local coverage determination.
R6 · 2018-10-01 · v31
Revision Effective Date: 10/01/2018: ICD-10 Codes that are Covered Removed: Group 3: C4A.11, C4A.12, C44.102, C44.109, C44.112, C44.119, C44.122, C44.129, C44.192, C44.199, Group 4: C4A.11, C4A.12, Group 6: C43.11, C43.12, D03.11, D03.12, Group 8: C43.11, C43.12, D03.11, D03.12, Group 9: C4A.11, C4A.12 Added: New expanded ICD-10 codes for those removed 09/27/2018: 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.
R6 · 2018-10-01 · v31
Revision Effective Date: 10/01/2018: ICD-10 Codes that are Covered Removed: Group 3: C4A.11, C4A.12, C44.102, C44.109, C44.112, C44.119, C44.122, C44.129, C44.192, C44.199, Group 4: C4A.11, C4A.12, Group 6: C43.11, C43.12, D03.11, D03.12, Group 8: C43.11, C43.12, D03.11, D03.12, Group 9: C4A.11, C4A.12 Added: New expanded ICD-10 codes for those removed 09/27/2018: 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.
R5 · 2017-10-01 · v24
Revision Effective Date: 10/01/2017: Covered ICD-10 Codes Deleted: Non-valid ICD-10 code C96.2 from group 1, 3, 4, 5 and 7
R5 · 2017-10-01 · v24
Revision Effective Date: 10/01/2017: Covered ICD-10 Codes Deleted: Non-valid ICD-10 code C96.2 from group 1, 3, 4, 5 and 7
R4 · 2017-01-01 · v19
Revision Effective Date: 01/01/2017 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: Billing and Modifier requirements COVERED ICD-10 CODES: Added: Group 2 codes C7A.090 and Z85.110 - Effective 10/01/2015 RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements Language Article
R4 · 2017-01-01 · v19
Revision Effective Date: 01/01/2017 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: Billing and Modifier requirements COVERED ICD-10 CODES: Added: Group 2 codes C7A.090 and Z85.110 - Effective 10/01/2015 RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements Language Article
R3 · 2016-10-01 · v13
Revision Effective Date: 10/01/2016 ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Added: New ICD-10 Code per Annual ICD-10 Codes Updates in Group 2, 3, 4 and 9 Revised: ICD-10 Code descriptions per Annual ICD-10 Codes Updates
R3 · 2016-10-01 · v13
Revision Effective Date: 10/01/2016 ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Added: New ICD-10 Code per Annual ICD-10 Codes Updates in Group 2, 3, 4 and 9 Revised: ICD-10 Code descriptions per Annual ICD-10 Codes Updates
R2 · 2016-07-01 · v6
Revision Effective Date: 10/01/2015 Covered ICD-10 Codes: Added: C7B.00, C7B.01, C7B.02, C7B.03, C7B.04 and C7B.09 to Groups 2 and 8 (Effective 10/01/2015)
R2 · 2016-07-01 · v6
Revision Effective Date: 10/01/2015 Covered ICD-10 Codes: Added: C7B.00, C7B.01, C7B.02, C7B.03, C7B.04 and C7B.09 to Groups 2 and 8 (Effective 10/01/2015)
R1 · 2016-07-01 · v3
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 · 2016-07-01 · v3
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.
Receipts for auditors
Version 76 of Article A52479, shown on this page: in force by CMS's dates 2026-10-01 onward. Archived 2026-10-02. CMS's copy · Our archived file. 5 of 5 sections are proven word-identical to the archived file.
Every archived version of Article A52479 (35 versions, CMS's dates, window by the as-of rule).
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| Article A52479 | version 2 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 2 | 2015-10-01 to 2016-06-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 3 | 2016-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 3 | 2016-07-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 6 | 2016-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 6 | 2016-07-01 to 2016-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 13 | 2016-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 13 | 2016-10-01 to 2016-12-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 19 | 2017-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 19 | 2017-01-01 to 2017-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 24 | 2017-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 24 | 2017-10-01 to 2018-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 31 | 2018-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 31 | 2018-10-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 33 | 2018-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 33 | 2018-10-01 to 2019-07-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 35 | 2019-08-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 35 | 2019-08-01 to 2019-12-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 39 | 2020-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 39 | 2020-01-01 to 2021-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 42 | 2021-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 42 | 2021-10-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 44 | 2021-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 44 | 2021-10-01 to 2022-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 49 | 2022-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 49 | 2022-10-01 to 2023-07-05 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 53 | 2023-07-06, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 53 | 2023-07-06 to 2023-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 59 | 2023-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 59 | 2023-10-01 to 2024-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 64 | 2024-10-01 to 2025-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52479 | version 67 no generated page | 2025-10-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52479 | version 69 no generated page | 2025-10-01 to 2025-12-31 | 2026-10-09 | CMS's copy · Our archived file |
| Article A52479 | version 73 | 2026-01-01 to 2026-09-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52479 | version 76 shown | 2026-10-01 to today | 2026-10-02 | CMS's copy · Our archived file |
Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.
CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.
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.