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Automatic External Defibrillators
LCD L33690 · 8 versions, 2015 to today · last changed 2020-01-01 (R7)
Version 2 of LCD L33690: in force by CMS's dates 2015-10-01 to 2015-09-30. The policy text on this page comes from this archived version.
JA · Noridian 16013
JB · CGS 17013
JC · CGS 18003
JD · Noridian 19003
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.
Sections in this version: Coverage Indications, Limitations, and/or Medical Necessity · Coding Information · Associated Information. Plus 5 sections marked N/A in this version.
Full verbatim text serves to customers · Customer? Log in
Version history, LCD L33690
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 Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask.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, 7 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.
R7 · 2020-01-01 · v20
Revision Effective Date: 01/01/2020 CODING INFORMATION: Removed: Field titled “Bill Type” Removed: Field titled “Revenue Codes” Removed: Field titled “ICD-10 Codes that Support Medical Necessity” Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity” Removed: Field titled “Additional ICD-10 Information” As required by CR 10901, the ICD-10 information has been moved to all Policy Articles. There is no change in coverage.
R6 · 2020-01-01 · v18
Revision Effective Date: 01/01/2020 COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Revised: “ordering physician” to “treating practitioner” Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA Added: Statement to refer to ICD-10 code section in the LCD-related Policy Article Revised: Order information as a result of Final Rule 1713 GENERAL DOCUMENTATION REQUIREMENTS: Revised: Prescriptions (orders) to SWO APPENDICES: Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA Added: Statement to refer to ICD-10 code section in the LCD-related Policy Article 02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.
R5 · 2019-01-01 · v14
Revision Effective Date: 01/01/2019 COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY: Removed: Statement to refer to diagnosis code section below Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY: Moved: Statement about noncovered diagnosis codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction APPENDICES: Revised: Reference to the applicable diagnosis code section
R4 · 2017-01-01 · v9
Revision Effective Date: 01/01/2017 COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Removed: Standard Documentation Language Added: New reference language and directions to Standard Documentation Requirements Added: General Requirements DOCUMENTATION REQUIREMENTS: Removed: Standard Documentation Language Added: General Documentation Requirements Added: New reference language and directions to Standard Documentation Requirements POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Removed: Standard Documentation Language Added: Direction to Standard Documentation Requirements Removed: Supplier Manual reference from Miscellaneous Removed: PIM reference from Appendices RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements article
R3 · 2016-07-01 · v7
Revision Effective Date 07/01/2016 COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Revised: Standard Documentation language - ACA order requirements – Effective 04/28/16 DOCUMENTATION REQUIREMENTS: Revised: Standard documentation language for orders, ACA requirements, and Proof of delivery instructions; added New order requirements, and Correct coding instructions – Effective 04/28/16
R2 · 2016-07-01 · v5
Effective July 1, 2016 oversight for DME MAC LCDs 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 LCDs.
R1 · 2015-10-01 · v3
Revision Effective Date: 10/31/2014 COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility DOCUMENTATION REQUIREMENTS: Revised: Standard Documentation Language to add who can enter date of delivery date on the POD Added: Instructions for Equipment Retained from a Prior Payer Revised: Repair to beneficiary-owned DMEPOS
Receipts for auditors
Version 2 of LCD L33690, shown on this page: in force by CMS's dates 2015-10-01 to 2015-09-30. Archived 2026-09-26. CMS's copy · Our archived file. 8 of 8 sections are proven word-identical to the archived file.
Every archived version of LCD L33690 (8 versions, CMS's dates, window by the as-of rule). The Article rows are the Article versions in force on the start dates of these LCD versions.
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| LCD L33690 | version 2 shown | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33690 | version 3 | 2015-10-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33690 | version 5 | 2016-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33690 | version 7 | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33690 | version 9 | 2017-01-01 to 2018-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33690 | version 14 | 2019-01-01 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33690 | version 18 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| LCD L33690 | version 20 | 2020-01-01 to today | 2026-09-26 | CMS's copy · Our archived file |
| Article A52458 | version 3 | 2015-10-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52458 | version 6 | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52458 | version 9 | 2017-01-01 to 2018-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52458 | version 13 | 2019-01-01 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52458 | version 28 | 2020-01-01 to 2022-09-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A55426 | version 12 | 2017-01-01 to 2017-04-19 | 2026-09-26 | CMS's copy · Our archived file |
| Article A55426 | version 62 | 2019-01-01 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A55426 | version 72 | 2020-01-01 to 2020-04-05 | 2026-09-26 | 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.