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LCD L33784 · 7 versions, 2015 to today · last changed 2020-01-01 (R6)
Version 21 of LCD L33784: in force by CMS's dates 2020-01-01 onward. 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.
CMS's newest revision note (R6, 2020-01-01), quoted
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.
source
This quote comes from CMS's revision-history file, not from the version's own file: Our archived file.
Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Associated Information. Plus 10 sections marked N/A in this version.
Full verbatim text serves to customers · Customer? Log in
Version history, LCD L33784
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 Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask.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, 5 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.
R6 · 2020-01-01 · v21
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.
R4 · 2017-01-01 · v11
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 under Miscellaneous Removed: PIM reference under Appendices RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements article
R3 · 2016-07-01 · v9
Revision Effective Date: 07/01/2016 DOCUMENTATION REQUIREMENTS: Revised: Standard Documentation Language for orders, and Proof of delivery instructions, added New order requirements, and Correct coding instructions; (Effective 04/28/2016)
R2 · 2016-07-01 · v7
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 · v5
Revision Effective Date: 10/31/2014: INDICATIONS AND LIMITATIONS OF COVERAGE AND MEDICAL NECESSITY: Revised: Standard Documentation Language regarding Medicare coverage DOCUMENTATION REQUIREMENTS: Added: Instructions for Refill Documentation Revised: Standard Documentation Language to add who can enter date of delivery date on the POD Revised: Moved continued need above continued use documentation Added: Equipment Retained from a Prior Payer Added: Instructions for Repair Replacement to beneficiary-owned DMEPOS
Receipts for auditors
Version 21 of LCD L33784, shown on this page: in force by CMS's dates 2020-01-01 onward. Archived 2026-09-26. CMS's copy · Our archived file. 13 of 13 sections are proven word-identical to the archived file.
Every archived version of LCD L33784 (7 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 L33784 | version 2 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33784 | version 5 | 2015-10-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33784 | version 7 | 2016-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33784 | version 9 | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33784 | version 11 | 2017-01-01 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33784 | version 19 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| LCD L33784 | version 21 shown | 2020-01-01 to today | 2026-09-26 | CMS's copy · Our archived file |
| Article A52502 | version 2 | 2015-10-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52502 | version 5 | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52502 | version 7 | 2017-01-01 to 2018-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52502 | version 20 | 2020-01-01 to today | 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 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.