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Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.

Parenteral Nutrition

LCD L38953 · 4 versions, 2021 to today · last changed 2024-01-01 (R3)

Version 12 of LCD L38953: in force by CMS's dates 2023-07-02 to 2023-12-31. 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 12 (2023-07-02 to 2023-12-31). Version 16 is in force today.

Codes CMS lists in this LCD's current version (version 16, 23 codes). CMS's download carries no list for version 12: B4164 B4168 B4172 B4176 B4178 B4180 B4185 B4187 B4189 B4193 B4197 B4199 B4216 B4220 B4222 B4224 B5000 B5100 B5200 B9004 B9006 B9999 E0776

Sections in this version: Coverage Indications, Limitations, and/or Medical Necessity · Summary of Evidence · Analysis of Evidence (Rationale for Determination) · Coding Information · Associated Information. Plus 3 sections marked N/A in this version.

Full verbatim text serves to customers · Customer? Log in

Version history, LCD L38953

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. Version numbers CMS never published to its archive do not exist as documents.

Revision history, every version

CMS's own change log, quoted, 3 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.

R3 · 2024-01-01 · v16
Revision Effective Date: 01/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: “and document an affirmative response” to language that pertains to contact with the beneficiary or caregiver/designee for DMEPOS products supplied as refills
Revised: “approaching exhaustion” to “expected to end” in regard to existing supplies
Revised: “Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date.” to “Contact with the beneficiary or designee regarding refills must take place no sooner than 30 calendar days prior to the expected end of the current supply.”
Revised: “For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product.” to “For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the expected end of the current supply.”
SUMMARY OF EVIDENCE:
Removed: Summary of evidence information, due to not being applicable to the non-discretionary changes
ANALYSIS OF EVIDENCE (RATIONALE FOR DETERMINATION):
Removed: Analysis of evidence information, due to not being applicable to the non-discretionary changes


12/14/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to refill requirement information per CMS Final Rule CMS-1780-F.
R2 · 2023-07-02 · v12
Revision Effective Date: 07/02/2023
SUMMARY OF EVIDENCE:
Added: Information related to GA, GY, GZ, and KX modifier addition
ANALYSIS OF EVIDENCE:
Added: Information related to GA, GY, GZ, and KX modifier addition
CODING INFORMATION:
Added: GA, GY, GZ and KX modifiers
RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments (A59399)
R1 · 2022-01-01 · v8
Revision Effective Date: 01/01/2022
CMS NATIONAL COVERAGE POLICY:
Removed: Reference to Medicare National Coverage Determinations Manual (CMS Pub. 100-03), Chapter 1, Part 3, Section 180.2. NCD was retired for claims with dates of service on and after January 1, 2022
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Reference to Medicare National Coverage Determinations Manual (CMS Pub. 100-03), Chapter 1, Part 3, Section 180.2. NCD was retired for claims with dates of service on and after January 1, 2022


03/10/2022: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS’ retiring of the National Coverage Determination.
Receipts for auditors

Version 12 of LCD L38953, shown on this page: in force by CMS's dates 2023-07-02 to 2023-12-31. 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 L38953 (4 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.

DocumentVersionIn forceArchived onVerify
LCD L38953version 42021-09-05 to 2021-12-312026-09-26CMS's copy · Our archived file
LCD L38953version 82022-01-01 to 2023-07-012026-09-26CMS's copy · Our archived file
LCD L38953version 12 shown2023-07-02 to 2023-12-312026-09-26CMS's copy · Our archived file
LCD L38953version 162024-01-01 to today2026-09-26CMS's copy · Our archived file
Article A55426version 912020-04-06 to 2022-12-312026-09-26CMS's copy · Our archived file
Article A55426version 1032023-01-01 to 2023-12-312026-09-26CMS's copy · Our archived file
Article A55426version 1322024-01-01 to today2026-09-26CMS's copy · Our archived file
Article A58836version 82021-09-05 to 2022-12-312026-09-26CMS's copy · Our archived file
Article A58836version 202023-07-02 to today2026-09-26CMS'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.