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Tag: LCD

Also Noted

Medicare keeps coverage for wheelchair trays

March 28, 2017HME News Staff

WASHINGTON - Medicare made a clerical error when it said it considered wheelchair trays, tables or similar products convenience items. The agency said claims for E0950 would be denied as statutorily non-covered, no benefit, according to an LCD and policy article revision posted by the DME MACs on March 16. The article was corrected on March 30. The change was set to take effect retroactively on Jan. 1, 2017. Concerns with the change included the medical necessity of these items and the timing. “They...

Coverage, LCD, wheelchair trays

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Specialty Providers

CMS holds off on coverage changes for prostheses

November 3, 2015HME News Staff

WASHINGTON - CMS has taken a step back from its controversial plans to change the coverage requirements for lower limb prostheses.The agency's DME MACs released a draft local coverage determination in July, setting off a chain of events that included a public hearing, a protest, high-stakes meetings and a “We the People” petition.“Both CMS and its contractors have heard your concerns about access to prostheses for Medicare beneficiaries,” the agency stated in an announcement...

Coverage Requirements, LCD, Prostheses

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Also Noted

Review finds 80% error rate for power wheelchairs

February 28, 2013HME News Staff

WASHINGTON - A prepayment review of power wheelchair claims processed in Jurisdiction B resulted in an 80% error rate, according to National Government Services (NSG), the DME MAC there. Of 1,022 claims processed from Oct. 1 2012­-Dec. 31, 2012, 122 were paid in full, while the remaining claims were completely or partially denied, according to the review. The most common reasons for denials were: Local Coverage Determination (LCD) criteria not met; face-to-face examination with a physician not established;...

DME MAC Jurisdiction B, LCD, Mobility, National Government Services, PMD, Power wheelchairs

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In brief: PMD hearing, LCD update, ASP figures

September 14, 2012HME News Staff

WASHINGTON - A Senate Aging Committee hearing this week will focus on new Medicare prior authorization requirements for power mobility devices (PMDs). The hearing, scheduled for Wednesday, Sept. 19, at 2 p.m., will review a three-year CMS demonstration project requiring prior authorizations for PMDs in seven states. The states under the microscope—California, Illinois, Michigan, New York, North Carolina, Florida and Texas—are where government officials believe PMD fraud is most prevalent....

Fraud, LCD, Oxygen, PMD

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Also Noted

Oxygen LCD gets updated

September 14, 2012HME News Staff

NASHVILLE, Tenn. - CGS, the DME MAC for Jurisdiction C, posted changes to the local coverage determination (LCD) for oxygen on Sept. 13. Two big changes: exercise testing must be supervised by a physician or other qualified individual; and home sleep testing requirements are limited to standalone overnight pulse oximetry. The revised LCD goes into effect Oct. 1, 2012.