Parenteral Nutrition

The DME MACs are retiring the Parenteral Nutrition LCD (L33798) and related Policy Article (A52515) 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: 01/01/2020
 COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
 Revised: “ordering physician” to “treating practitioner”
 NUTRIENTS:
 Revised: “ordering physician” to “treating practitioner”
 Revised: Format of HCPCS codes, from ‘code spans’ to individually-listed HCPCS
 EQUIPMENT AND SUPPLIES:
 Revised: Format of HCPCS code references, from ‘code spans’ to individually-listed HCPCS
 GENERAL:
 Revised: Order information as a result of Final Rule 1713
 REFILL REQUIREMENTS:
 Revised: “ordering physicians” to “treating practitioners”
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”
 DOCUMENTATION REQUIREMENTS:
 Revised: “physician’s” to “treating practitioner’s”
 GENERAL DOCUMENTATION REQUIREMENTS:
 Revised: “Prescriptions (orders)” to “SWO”


02/20/2020: 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, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

Revision Effective Date: 01/01/2020
 COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
 Added: B4187 to NUTRIENTS section
 HCPCS CODES:
 Revised: Code narrative for B4185
 Added: B4187 to Group 1

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
Revised: Refill 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: Reference under Miscellaneous and Appendices
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article

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.

Revision Effective Date: 01/01/2016
HCPCS CODES:
Group 1 codes:
Updated: HCPCS Code B5000, B5100, B5200 narrative description
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language to remove start date verbiage from Prescription Requirements (Effective 11/05/2015)

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
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Instructions for Recertification DIF