Pneumatic Compression Devices - Policy Article - Effective December 2015

The DME MACs are retiring the Pneumatic Compression Devices LCD (L33829) and related Policy Article (A52488) effective for claims with dates of service on or after November 14, 2024, due to existence of National Coverage Determination 280.6


10/03/2024: 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.

Revision Effective Date: 10/22/2023
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: Table containing only a description of HCPCS code E0676
Added: Full description of E0676 within last sentence
CODING GUIDELINES:
Removed: "etc"
Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review


09/07/2023: 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.

Revision Effective Date: 01/01/2023
GENERAL:
Removed: "The documentation for each of the above must include careful, detailed records of measurements, obtained in the same manner and with reference to the same anatomic landmarks, prior to, at periodic times during and at the conclusion of the various trials and therapy, with bilateral comparisons where appropriate." (effective June 7, 2022)


07/20/2023: 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.

Revision Effective Date: 01/01/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Billing information relevant to CMNs, for DOS affected by the CMN elimination
Revised: Direction for dates of service for which a CMN is required


12/01/2022: 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.

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.

Revision Effective Date: 01/01/2020
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):
Remove: Entire section based on Final Rule 1713
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
 CERTIFICATE OF MEDICAL NECESSITY (CMN):
Revised: Section header to remove PIM reference
Revised: “physician” to “treating practitioner”
 Revised: Detailed Written Order to SWO
Removed: CMN DME form version number
 CODING GUIDELINES:
 Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
 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”


02/20/2020: 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.

02/28/2019: 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.

Revision Effective Date: 01/01/2017
CODING GUIDELINES:
Revised: Coding guidelines for clarification


04/12/2018: 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.

Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: 42 CFR 410.38(g)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: General and CMN requirements
CODING GUIDELINES:
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements Language Article

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.

Revision Effective Date: 12/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: Start date verbiage from Prescription Requirements (Effective 11/05/2015)

Revision Effective Date: 12/01/2015 (Draft Released to Final)
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Prevention of Venous Thrombolism exclusion from coverage
Added: Statutorily denial language for E0676
Added: E0675 to ACA 6407 requirements table
CODING GUIDELINES:
Added: Coding instructions for Sleeves E0656 and E0657
Added: Coding instructions for E0675
Added: E0675 to the Coding Verification Review

Revision Effective Date: 10/31/2014
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: “When required by state law” from ACA new prescription requirements
Revised: Face-to-Face Requirements for treating practitioner