CMS LCD Format to change in 2017

Click Here to Read All Latest News Alerts!

External Breast Prosthesis LCD Format Change

The DME MACs for all four Jurisdictions, in a joint statement published on their websites, announced Thursday that they will be “revising the DOCUMENTATION REQUIREMENTS section of all Local Coverage Determinations (LCDs) during our CMS-required annual LCD review. The LCD updates will be published in early 2017.”

At that time they will  revert to the previous LCD format that existed prior to 2011, and general documentation requirements that have appeared within individual policies (LCDs) will be removed from all DME MAC LCDs.

What this means for Post Mastectomy providers.

The Documentation requirements will be spread across several documents: General requirements will be located in the new, separate, Standard Documentation LCD related Policy Article. this will be the same for all Jurisdictions, A-D; POLICY SPECIFIC DOCUMENTATION REQUIREMENTS from  External Breast Prosthesis Policy Article Local Coverage Determination (LCD) policy will be located in the External Breast Prosthesis Policy Article.  Additionally, the Supplier Manual will contact

The DME MACs remind suppliers that, “Suppliers are reminded that these changes in the LCD format do not add any new requirements, nor remove any existing Medicare documentation requirements. In the event of a claim review (audit), the LCD format change does not obviate a supplier’s obligation to provide sufficient documentation to demonstrate compliance with Medicare payment rules.


Link to full announcement