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Parenteral Nutrition

LCD L33798 · 8 versions, 2015 to today · last changed 2020-11-12 (R7)

Version 4 of LCD L33798: in force by CMS's dates 2015-10-01 to 2015-12-31. The policy text on this page comes from this archived version.

DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
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.

You are viewing version 4 (2015-10-01 to 2015-12-31). No version of LCD L33798 is in force today.

Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Coding Information · Associated Information · Sources of Information and Basis for Decision. Plus 3 sections marked N/A in this version.

Full verbatim text serves to customers · Customer? Log in

Version history, LCD L33798

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 Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask.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 · 2020-11-12 · v26
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.
R6 · 2020-01-01 · v25
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).
R5 · 2020-01-01 · v19
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
R4 · 2017-01-01 · v12
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
R3 · 2016-07-01 · v9
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.
R2 · 2016-01-01 · v8
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)
R1 · 2015-10-01 · v4
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
Receipts for auditors

Version 4 of LCD L33798, shown on this page: in force by CMS's dates 2015-10-01 to 2015-12-31. 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 L33798 (8 versions, CMS's dates, window by the as-of rule).

DocumentVersionIn forceArchived onVerify
LCD L33798version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33798version 4 shown2015-10-01 to 2015-12-312026-09-26CMS's copy · Our archived file
LCD L33798version 82016-01-01 to 2016-06-302026-09-26CMS's copy · Our archived file
LCD L33798version 92016-07-01 to 2016-12-312026-09-26CMS's copy · Our archived file
LCD L33798version 122017-01-01 to 2019-12-312026-09-26CMS's copy · Our archived file
LCD L33798version 192020-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33798version 252020-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33798version 262020-01-01 to 2020-11-122026-09-26CMS'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.