Enteral Nutrition - Policy Article

The DME MACs are retiring the Enteral Nutrition LCD (L33783) and related Policy Article (A52493) effective for claims with dates of service on or after November 12, 2020 due to the evolution of enteral nutrition clinical paradigms.
10/08/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This is not a new LCD nor is it a revision to an LCD, therefore does not require comment and notice.

Revision Effective Date: 04/30/2020
CODING GUIDELINES:
Removed: Statement indicating calorically dense formulas that include characteristics of other HCPCS codes, will be coded based on the calorically dense characteristic
04/30/2020: 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.

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: “attending physician” to “treating practitioner”
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed HCPCS
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
DME INFORMATION FORM (DIF):
Revised: “ordering physician” to “treating practitioner”
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed HCPCS
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”
02/06/2020: 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.

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: 'these supplies' to 'these supply allowances' for enteral feeding supplies
Added: In-Line Cartridge Coding Guidelines and billing instructions for Q9994 and B4105

02/14/2019: 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.

Revision Effective Date: 01/01/2017
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Updated: "patient" to "beneficiary
CODING GUIDELINES:
Revised: Typographical, updated code set to represent a span


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.

Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Supply payment allowance for HCPCS B4034 – B4036
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: DIF requirements
Updated: Recertification DIF to revised DIF
CODING GUIDELINES:
Revised: Coding guidelines of items included in the feeding supply allowance
Added: Guidelines for blenderized and calorically dense formulations
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: 10/31/2014
CODING GUIDELINES:
Updated: Standard language documentation for PDAC coding verification