DRAFT - Surgical Dressings - Policy Article - Effective XXXX XXXX

Revised Effective Date: 12/05/2024
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS
Removed: “The size of the dressing (if applicable); and,” from the documentation list the treating practitioner’s medical record, nursing home, or home care nursing records must specify for initial wound evaluations
Added: “Claim lines for A6501, A6502, A6503, A6504, A6505, A6506, A6507, A6508, A6509, A6510, A6511, A6512, and A6513 do not require the A1-A9 modifier or the AW modifier.”


12/05/2024: 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.

Revised Effective Date: 01/01/2024
CODING GUIDELINES:
Revised: Examples of when to use A1-A9 modifiers, as clarification
Revised: “on a surgical or debrided wound” to “on a qualifying surgical or debrided wound” in regard to A1-A9 modifier usage, as clarification
Revised: “number of wounds” to “number of qualifying wounds” in regard to A1-A9 modifier usage, as clarification


02/29/2024: 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.

Revised Effective Date: 01/01/2024
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: “Gradient compression stockings (A6530, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6544, A6549)”
Added: “Gradient compression stockings (A6530, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6544, A6549) are non-covered under the surgical dressing benefit because they do not meet the statutory definition of a dressing; however, they may be considered for coverage under the lymphedema compression treatment items benefit and billed in accordance with CMS Final Rule CMS-1780-F.”


01/18/2024: 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.

Revised Effective Date: 09/07/2023
CODING GUIDELINES:
Removed: “It has a non-adherent property over the wound site” regarding foam dressing HCPCS codes A6209, A6210, A6211, A6212, A6213, A6214, A6215


 09/07/2023: 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.

Revised Effective Date: 05/01/2021
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.

Revised Effective Date: 05/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Roman to Arabic numerals in staging scheme
CODING GUIDELINES:
Revised: Roman to Arabic numerals in staging scheme
Added: “(CVR)” after reference to coding verification review
Added: “(PCL)” after reference to “Product Classification List”
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review


03/18/2021: 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.

Revised Effective Date: 01/01/2020
QUALIFYING DRESSING REQUIREMENTS:
Revised: Indication that eligible products “include both” to “are defined as”
Revised: Eligible product information, to include definitions of primary and secondary dressings
CODING GUIDELINES:
Added: Coding guidelines for Alginate or Other Fiber Gelling Dressings (A6196, A6197, A6198)
Revised: Clarified wound fillers as primary dressings
Revised: Clarified wound covers as primary or secondary dressings
Added: Clarification regarding sizing related to adhesive borders


10/15/2020: 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
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: Included descriptor of the A9 modifier
06/25/2020: 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
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Directional statement regarding practitioner as supplier
Added: Financial interest prohibition exception for practitioners who are also the supplier
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed
CODING GUIDELINES:
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed


06/04/2020: 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

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
 Revised: Initial wound evaluation record specifications
Clarified: Direction
on need for weekly evaluations
 Added: Statement that the person doing the evaluation may have no financial relation with the supplier
 Clarified: Ongoing evaluations as “weekly or monthly”


03/05/2020: 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
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217)
 Added: Entire section regarding the new rule
 QUALIFYING WOUND:
 Revised: “physician” updated to “treating practitioner”
 MISCELLANEOUS:
 Revised: “physician” updated to “treating practitioner”
 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
 Revised: Statement “The order must specify” and updated to “For initial wound evaluations, the treating practitioner’s medical record, nursing home, or home care nursing records must specify:”
 Added: Additional requirements to “For initial wound evaluations, the treating practitioner’s medical record, nursing home, or home care nursing records must specify”
 Revised: “physician” updated to “treating practitioner”
 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”


01/09/2020: 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

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Qualifying wound wording to match language in the Benefit Policy Manual
 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
 Removed: Expected duration of need from order specifications
 CODING GUIDELINES:
 Revised: RT and/or LT modifier instructions


02/28/2019: 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: 07/24/2017
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Order and Modifier requirements
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.