Tag: Local coverage determination

WASHINGTON – The DME MACs have published an updated FAQ to provide additional guidance related to the new local coverage determination for home oxygen therapy.  The FAQ comprises 25 questions related to continued need, the new N modifiers and more.  AAHomecare highlighted the following questions in a bulletin:  1. Is an initial F2F evaluation required?  Answer: While there’s no formal requirement in the NCD or LCD, good medical practice would dictate...

WASHINGTON – AAHomecare strongly supported CMS’s proposed local coverage determination for continuous glucose monitors in recent submitted comments. The proposed LCD would, among other things, remove the requirement for multiple administration of insulin and frequent self-adjustments, and allow for telehealth visits in place of in-person visits. The association, however, has concerns about the ability of DMEPOS providers to collect documentation from prescriber medical records that’s...

WASHINGTON – CMS has published a new local coverage and policy article for oxygen and oxygen equipment, AAHomecare reports.  Here is a link to the LCD: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33797  Here is a link to the policy article: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52514  The new LCD goes into effect Jan. 1.  CMS is not required to provide a comment period, because the LCD contains what...

WASHINGTON – CMS has published a proposed LCD that modifies the coverage criteria for continuous glucose monitors (CGMs) based on the best available evidence.  The agency seeks to modify criteria to allow coverage of a CGM for beneficiaries with diabetes mellitus who are insulin treated or have a history of problematic hypoglycemia. Problematic hypoglycemia is defined as:  recurrent level 2 hypoglycemic events (

ALEXANDRIA, Va. - The DME MACs will retire their local coverage determinations for parenteral nutrition and enteral nutrition effective Nov. 12, according to the National Home Infusion Association. The NHIA commends the move, saying the LCDs for parenteral nutrition and enteral nutrition “cause delays in access to care for Medicare beneficiaries with gastrointestinal disabilities and are administratively burdensome for hospitals, physicians and home infusion pharmacies,” the association...

WASHINGTON - Two senators recently introduced a bill that seeks to improve the transparency and accountability of the local coverage determination (LCD) process performed by the Medicare Administrative Contractors (MACs). The Local Coverage Determination Clarification Act of 2016 would: require open and public meetings with the MACs that are on the record; require disclosure by the MACs of the rationale for an LCD and the evidence for that decision at the beginning of the process; provide stakeholders...