Tag: Local Coverage Determination (LCD)
MACs withdraw new coverage policies for skin substitutes
December 29, 2025HME News Staff
WASHINGTON – The A/B Medicare Administrative Contractors (MACs) are withdrawing the local coverage determinations (LCDs) for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers that were scheduled to go into effect Jan. 1, 2026.
The Centers for Medicare & Medicaid Services (CMS) made the announcement on Dec. 24, only days after announcing that the MACs would release updated LCDs that...
MACs to issue final LCDs for skin substitute products effective Jan. 1, 2026
December 17, 2025HME News Staff
WASHINGTON – The seven A/B Medicare Administrative Contractors (MACs) will release updated final Local Coverage Determinations (LCDs) for skin substitute grafts and cellular/tissue-based products used to treat diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) that will be effective Jan. 1, 2026, according to a Dec. 15 Fact Sheet from the Centers for Medicare & Medicaid Services (CMS).
Key highlights of the LCDs
Expanded access: Medicare...
New LCD for intermittent catheters expands coverage
November 17, 2025HME News Staff
WASHINGTON – Documentation of any spinal cord injury diagnosis is sufficient to establish Medicare coverage for sterile catheter kits (A4297 and A4353) starting Jan. 1, according to a new local coverage determination (LCD) and policy article from the Durable Medical Equipment Medicare Administrative Contractors (DME MACs).
The expanded coverage, which better aligns with current clinical evidence, will help to reduce serious urinary...
Proposed knee brace LCD ‘big win,’ says AOPA
July 28, 2025HME News Staff
WASHINGTON – The DME MACs have released a draft revision to the Knee Orthoses Local Coverage Determination (LCD) and its corresponding Policy Article.
DL 33318 comes nearly two years after the American Orthotic and Prosthetic Association (AOPA) made a formal LCD reconsideration request.
Under the new draft policy, Medicare would cover knee orthoses for medial or lateral tibiofemoral osteoarthritis without requiring joint instability, so long as the following are...
In brief: Fraud bill, LCD for prostheses, diamond anniversary
January 26, 2024HME News Staff
WASHINGTON – Sens. Mike Braun, R-Ind., and Bill Cassidy, R-La., have introduced legislation to target irregular billing for certain DME and other diagnostic products in the Medicare program.
The “Medicare Transaction Fraud Prevention Act” directs CMS to create a two-year pilot to oversee Medicare-covered purchasing of DME and other diagnostic testing related products for the 5% of beneficiaries that already receive electronic notices.
The bill, which would ask...
Home oxygen therapy: Stakeholders welcome ‘much-needed’ guidance
March 3, 2023Theresa Flaherty, Managing Editor
WASHINGTON – An updated FAQ published by the DME MACs in February, by and large, addresses concerns around the new local coverage determination for home oxygen therapy and serves as a good reference point as HME providers navigate a new era for the benefit, stakeholders say.
The FAQ, published Feb. 21 and updated Feb. 23, addresses 25 questions related to continued need, the new N modifiers and more.
“Full stop, it was a much-needed thing,” said Andrea Stark, a...
DME MACs provide additional guidance
February 21, 2023HME News Staff
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...
Oxygen LCD needs some ‘finer points’
December 2, 2022Theresa Flaherty, Managing Editor
Stakeholders have been eagerly awaiting the LCD and policy article, following a proposed national coverage determination for oxygen published in July 2021 and a final NCD in September 2021.
As with any change this significant, the devil is in the details, and stakeholders are calling some parts of the LCD and policy article “muddied.”
At the end of the day, stakeholders say providers need clear documentation from physicians and treating practitioners.
WASHINGTON...
AAH responds to proposed LCD for CGMs
November 21, 2022HME News Staff
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...
CMS publishes LCD for oxygen
November 18, 2022HME News Staff
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...