Advisory Articles




Advisory Articles Articles


Billing of Powered L-Coded Items - Correct Coding - RevisedL1005 - Tension Based Scoliosis Orthosis and Accessory Pads, Includes Fitting and Adjustment - Correct CodingRetired - Correct Coding - MyoPro (Myomo, Inc.) Assist Device - RevisedRetired - Correct Coding - Powered Exoskeleton ProductsL1686 Prefabricated Hip Abduction Orthosis - Correct CodingRetired - Correct Coding and Coverage of Ventilators – Revised April 2019Scoliosis Brace - Correct CodingRetired - Correct Coding and Coverage - Panzyga® (Immunoglobulin Intravenous (Human), 10%)Correct Coding - U 500 Insulin for Use in External Insulin Infusion PumpsCorrect Coding – 2019 HCPCS Code Annual Update - CorrectedCorrect Coding for Items Used to Treat Edema - RevisedContinuous Glucose Monitor Supplies - Correct Coding and BillingKF Modifier Use - Correct CodingPanzyga® (Immunoglobulin Intravenous (Human), 10%) Correct Coding and Coverage - Revised2020 HCPCS Code Annual Update - Correct Coding - RevisedPartial Hand Prostheses - Correct CodingNew HCPCS Code - Revefenacin (Yupelri®) - J7677Retired - Correct Coding for Pneumatic Compression DevicesRetired - Ankle-Foot Orthoses – Arizona-Type – Correct CodingSPEECH GENERATING DEVICE – INFORMATION REQUIRED FOR CODING VERIFICATION REVIEWSPEECH GENERATING DEVICES – CODING VERIFICATION REVIEW REQUIREMENT – UPDATERetired - Correct Coding - Lithium Batteries - UpdatedRetired - Coverage and Correct Coding of Continuous Glucose Monitoring (CGM) Devices - RevisedRetired - Coverage and Correct Coding of Continuous Glucose Monitoring DevicesCOVERAGE REMINDER – SPEECH GENERATING DEVICES Retired - Correct Coding - Negative Pressure Wound Therapy (NPWT)Retired - Continuous Glucose Monitors - Frequently Asked QuestionsRetired - Correct Coding – NOC Codes for Enteral (B9998) and Parenteral (B9999) NutritionRetired - Coding and Coverage - Therapeutic Continuous Glucose Monitors (CGM)Retired - Speech Generating Devices – Coding Verification Review RequirementRetired - Correct Coding - inFlow™ Intraurethral Valve-Pump (Vesiflo, Inc.)Retired - Correct Coding - Manual Wheelchairs Constructed of TitaniumRetired - Correct Coding and Coverage of Ventilators – Revised May 2016Retired - Correct Coding - 2019 HCPCS Code Annual UpdateRetired - Correct Coding - Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) Coverage Indicator ChangedRetired - Correct Coding - Inserts Used with Therapeutic Shoes for Persons with Diabetes (A5512, A5513, K0903)PDAC Coding Guidelines for Off-the-Shelf Diabetic Shoes (A5500)Retired - Correct Coding and Coverage of Ventilators - Revised January 2019Retired - Correct Coding – “No-Touch” CathetersRetired - Correct Coding Reminder - Duopa® (AbbVie)Retired - Correct Coding – Center Mounted Elevating Leg RestRetired - Correct Coding - Not Otherwise Classified (NOC) HCPCS Codes Used for DrugsRetired - Correct Coding and Coverage of VentilatorsRetired - Correct Coding and Coverage – Peristeen® Transanal Irrigation (PAI) SystemRetired - MyoPro™ - Coding ReminderRetired - Correct Coding - Center Mount Elevating Leg Rest - RevisedCorrect Coding - Lithium Batteries - RevisedL3960 - Coding Verification Review RequirementRetired - Coverage and Correct Coding of Blincyto™ – RevisedRetired - Correct Coding and Coverage - RELiZORB (Alcresta Therapeutics) In-Line CartridgeRetired - Correct Coding - Lithium BatteriesRetired - Correct Coding – Pneumatic Compression Devices and Related Appliances – RevisedRetired - Correct Coding - Otto Bock C-Leg Coding - RevisedRetired - Correct Coding – Billing of Powered L-Coded ItemsRetired - Glucose Monitors LCD and Related Policy Article - RevisedRetired - Correct Coding and Coverage of Ventilators – Revised Effective January 1, 2016Retired - Correct Coding - Articulating Digit(s) and Prosthetic HandsRetired - Spinal Orthosis – Coding Verification Review RequirementRetired - Charcot Restraint Orthotic Walker - Crow Boot - CodingRetired - Charcot Restraint Orthotic Walker – Crow Boot – Coding UpdateRetired - Coding Instructions - Microprocessor Controlled Knee ProsthesesRetired - Elastic Garments – NoncoveredRetired - Correct Coding – LIM Innovations Infinite Socket™Retired - Pneumatic Knee Splint – Coding Verification Review RequirementRetired - LIM Innovation Infinite Socket - Correct Coding - RevisedRetired - Correct Coding – LIM Innovation Below Knee SocketRetired - Correct Coding – LIM Innovations Infinite Socket™ – RevisedRetired - Coding Guidelines for Ankle Foot OrthosesRetired - Revised - Coding Guidelines for Ankle-Foot OrthosesRetired - Submitting Diabetic Shoe Inserts for CodingRetired - Correct Coding Instructions – Endolite Echelon® Prosthetic FootCorrect use of Not Otherwise Specified L-codes for Orthoses and Prostheses - Billing ReminderRetired - Correct Coding - MyoPro® (Myomo, Inc.) Assist DeviceMyoPro® (Myomo, Inc.) Assist Device - Correct Coding - RevisedRetired - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - RevisedRetired - Correct Coding – Definitions Used for Off–the–Shelf Versus Custom Fitted Prefabricated Orthotics (Braces) – RevisedRetired - Correct Coding and Billing for Microprocessor-Controlled Knee SystemsRetired - Correct Coding – Braces (Orthoses) Attached to WheelchairsRetired - Appropriate Coding and Billing of Lower Limb Prosthetic Covers and Covering SystemsRetired - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - RevisedInsulin Infusion Pumps with Integrated Continuous Glucose Sensing Capabilities and Related Accessories/Supplies – Codes E0787 and A4226 - Correct CodingCorrect Coding and Coverage of Ventilators - Revised July 2020Custom Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code - Correct CodingRetired - MyoPro® (Myomo, Inc.) Assist Device - Correct Coding - RevisedRetired - Incorrect Use of HCPCS Codes for Custom Fit OrthoticsRetired - Vacuum Erection Device – Coding Verification Review RequirementAnkle-Foot Orthoses - Arizona-Type - Correct Coding - RevisedRetired - Correct Coding – Whill Model A Powered Personal Mobility DeviceRetired - Correct Coding – Billing of HCPCS Code E0986Retired - Correct Coding – Bariatric Pressure Reducing Support SurfacesRetired - Correct Coding – Whill Powered Personal Mobility Devices – RevisedDefinitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Correct Coding - RevisedRetired - Correct Coding – Ankle Orthoses, With or Without Joints, Prefabricated or Custom Fabricated Coding Verification ReviewRetired – Correct Coding – Martin Bionics Socket-Less Socket – RevisedRetired - Hand-Finger Orthoses – Use of CG Modifier – RevisedRetired - Hand Finger Orthoses (L3923) - Use of CG ModifierCorrect Coding and Coverage – Braces Constructed Primarily of Elastic or Other Fabric Materials – RevisedRetired - Correct Coding and Coverage – Braces Constructed Primarily of Elastic or Other Fabric MaterialsRetired - Correct Coding – Submitting Diabetic Shoe Inserts for HCPCS Coding – PDAC Coding Application InstructionRetired - Ankle-Foot Orthoses – Arizona-Type – Correct Coding – RevisedRetired - Xembify® - Correct CodingRetired - Coverage and Correct Coding of Blincyto™Retired - Correct Coding – Eclipse™ Vaginal Insert System (Pelvalon, Inc.)Retired - Coverage and Coding – New Oral Antiemetic Drug Varubi™Retired – Correct Coding – Eclipse™ Vaginal Insert System (Pelvalon, Inc) - RevisedRetired - Coverage and Coding – New Oral Antiemetic Drug Varubi® – Revised – Effective Date July 1, 2016Retired - Coverage and Correct Coding of CUVITRU™Retired - Correct Coding – PRO-FLEX® Prosthetic Foot (Össur)Retired - Correct Coding – A5513 Product Coding Redetermination ProjectRetired - Correct Coding - PROSE ® DeviceRetired - Correct Coding - A5513 Custom Molding RequirementsCorrect Coding of CUVITRU™ - RevisedRetired - Endoskeletal Prosthetic Knee-Shin Systems - Correct CodingRetired - Correct Coding - Custom Fabricated Wheelchair Seat and Back CushionsCustom Fabricated Wheelchair Seat and Back Cushions - Correct Coding - RevisedRetired - Manual Wheelchair BasesRetired - Manual Wheelchair BasesManual Wheelchair Bases - Correct Coding - RevisedRetired - Coverage and Coding – New Oral Antiemetic Drug Akynzeo®Retired - Coverage and Coding – New Oral Antiemetic Drug Akynzeo® – RevisedRetired - Coverage and Correct Coding of HYQVIA (Immune Globulin Infusion (Human) 10%, with Recombinant Human Hyaluronidase) – RevisedRetired - Coverage and Correct Coding of HYQVIACoverage and Correct Coding of HYQVIA (Immune Globulin Infusion (Human) 10%, with Recombinant Human Hyaluronidase) – RevisedCorrect Coding – New Oral Antiemetic Drug Akynzeo® - RevisedRetired - Code Verification Review Requirement for Articulating Digit(s) and Prosthetic HandsCode Verification Review Requirement for Articulating Digit(s) and Prosthetic Hands - RevisedRetired - Heating Pads and Heat Lamps – Draft Medical Policy FinalizedIncorrect Use of HCPCS Code A9279 - Correct Coding - RevisedRetired - Incorrect Use of HCPCS Code A9279 - Correct Coding2021 HCPCS Code Update - April Edition - Correct CodingProsthetic Feet and Additions to Lower Limb Extremity Prostheses - Correct Coding and Coding Verification Review RequirementRetired - Revised – Collagen Surgical Dressings – Coding Verification Review RequirementRetired - Collagen Surgical Dressings – Coding Verification Review RequirementRetired - Ultrasonic/Electronic Aerosol Generator With Small Volume Nebulizer – Coding Verification Review RequirementCorrect Coding - Porta-Lung Negative Pressure Ventilator - RevisedRetired - Reminder - Ultrasonic/Electronic Aerosol Generator With Small Volume Nebulizer – Coding Verification Review RequirementRetired - Correct Coding Instructions – Porta-Lung® Negative Pressure VentilatorRetired - Correct Coding Reminder - Monitoring Technology Used With Positive Airway Pressure Devices (PAP) and Respiratory Assist Devices (RAD)Retired - Walker Unbundling Billing for BrakesRetired - HCPCS Code E0571 - InvalidRetired - Tracheostomy Care Kit - Coding GuidelinesRetired - Correct Coding Instructions – A4358 Urinary Collection BagRetired - Urological Supplies – A4353 Correct Coding Clarification Policy RevisionL1690 Prefabricated Bilateral Lumbo-sacral Hip Orthosis - Correct Coding - RevisedRetired - L1690 Prefabricated Bilateral Lumbo-sacral Hip Orthosis - Correct CodingRetired - 2020 HCPCS Code Update - October Edition - Correct Coding2020 HCPCS Code Update - October Edition - Correct Coding - RevisedRetired - 2021 HCPCS Code Update - July Edition - Correct Coding2021 HCPCS Code Update - July Edition - Correct Coding - RevisedRetired - Power Mobility Device Independent Testing RequirementsRetired - Coverage and Correct Coding of Duopa® (Levodopa-Carbidopa Enteral Suspension)Retired - Coverage and Correct Coding of Duopa® (Levodopa-Carbidopa Enteral Suspension) – RevisedRetired – Power Mobility Device Independent Testing Requirements - RevisedPower Mobility Device Independent Testing Requirements Effective October 1, 2015 - RevisedRetired - K0009 Manual Wheelchair - Coding Verification Review RequirementRetired - K0009 Manual Wheelchair – Coding Verification Review Requirement - RevisedRetired - K0009 Manual Wheelchair – Coding Verification Review Requirement – Deadline ExtendedRetired - K0009 Manual Wheelchair – Coding Verification Review Requirement – UpdateRetired - 2020 HCPCS Code Annual Update - Correct CodingWarranty, Reasonable Useful Lifetime (RUL), and the Minimum Lifetime Requirement (MLR) for Durable Medical Equipment - Correct Coding - RevisedRetired - Correct Coding - Warranty, Reasonable Useful Lifetime (RUL), and the Minimum Lifetime Requirement (MLR) for Durable Medical EquipmentInsulin Used with Continuous External Insulin Infusion Pumps - Correct Coding - RevisedRetired - Insulin Used with Continuous External Insulin Infusion Pumps - Correct CodingPureWick Urine Collection System - Coding and Billing Instructions2021 HCPCS Code Update - October Edition - Correct CodingMedicare Coverage for Shoes - Correct Coding - RevisedRescinded - Correct Coding – Surgical Dressings Containing Non-Covered ComponentsRetired - Correct Coding – Surgical Dressings Containing Medical HoneyRetired - Correct Coding – Liners used with Positive Airway Pressure (PAP) MaskRetired - Enteral Nutrition Supply Kits - B4034-B4036Retired - Functional Electrical Stimulators – New CodeRetired - PDAC Contract Effective August 18, 2008Retired - Clarification of Billing Surgical Dressings as Components of KitsBilling and Code Verification of HCPCS Code E0467 (Multi-Functional Ventilator) - Correct CodingArticulating Digit(s) and Prosthetic Hands - Correct Coding - RevisedRetired - Correct Coding - Articulating Digit(s) and Prosthetic Hands - RevisedRetired - Correct Coding of Finger, Hand, Hand-Finger and Wrist-Hand-Finger Braces (Orthoses)Correct Coding of Finger, Hand, Hand-Finger and Wrist-Hand-Finger Braces (Orthoses) - RevisedCorrect Coding of Elbow, Shoulder, Shoulder-Elbow-Wrist-Hand and Shoulder-Elbow-Wrist-Hand-Finger Braces (Orthoses)Partial Foot, Shoe Insert (Toe Fillers), and Shoe Inserts for Diabetics - Coding Based on Benefit Category - Correct Coding2022 HCPCS Code Update - January Edition - Correct CodingParenteral Nutrition - Correct Coding and Billing - RevisedEnteral Nutrition - Correct Coding and Billing - RevisedRetired - Parenteral Nutrition - Correct Coding and BillingRetired - Enteral Nutrition - Correct Coding and BillingCorrect Coding - 2017 HCPCS Code Annual UpdateCorrect Coding – 2016 HCPCS Code Annual UpdateHCPCS Code Update - 2014HCPCS Code Update - 2013HCPCS Code Update – 2012HCPCS Code Update - 2009Topical Oxygen Therapy Used For Wound Care - An UpdateCorrect Coding - A9286 - Hygienic Item or Device, Disposable or Non-disposable, Any Type, EachContinuous Glucose Monitors - Use of Smart DevicesCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Battery ChargerCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Battery ReplacementCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Replacement of Wheelchair Seat and Back UpholsteryCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Wheelchair TrayCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Wheelchair Ventilator TrayCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Drive Wheel Gear BoxCorrect Coding – Incorrect Use of HCPCS Code K0108 To Bill for a Wheelchair HeadrestHCPCS Codes K1018 and K1019 - Correct CodingCorrect Coding – Replacement Cecostomy TubeCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Anti-Tip Devices for Manual WheelchairsCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings: Calf Pad or Calf SupportCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings: Shoe Holder or Shoe Holder Replacement StrapsCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Labor ChargesCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Transit System and Associated BracketCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Privacy FlapCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Wheel Lock Brake Extension for Manual WheelchairsCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for an ActuatorCorrect Coding – 2018 HCPCS Code Annual UpdateCorrect Coding – Full Length Rocker Soles Added to Therapeutic ShoesCorrect Coding – Hygienic Cleansers, Diapers, and Under-PadsCorrect Coding – Hygienic Items, Wash Cloths, and Cleansing WipesCorrect Coding – Urinary Drainage Tube AdapterCorrect Coding – HCPCS Coding of Surgical Dressings – Components to Report on the PDAC HCPCS Code Verification ApplicationCorrect Coding – SpeediCath® Flex Coudé Catheter (Coloplast)Correct Coding – Interferential Current (IFC) Therapy DevicesCorrect Coding – Diapers and UnderpadsCorrect Coding – Oral Appliances Not Used for the Treatment of Obstructive Sleep ApneaCorrect Coding – Argus® II Retinal Prosthesis SystemCantilever Type Armrest – Correct CodingCorrect Coding and Coverage – Oral Suspensions Used in the Treatment of Oral Mucosal InjuriesCorrect Coding – HCPCS Coding Recommendations from Non-Medicare SourcesCorrect Coding – IDEO and ExoSym Energy Storing AFOCorrect Coding – Buzzy®Correct Coding – Diathermy and Biofeedback DevicesCorrect Coding – P-stim® DeviceCorrect Coding – TOBI® Podhaler™Correct Coding – Tracheostomy TubesCoverage and Correct Coding of YONDELIS®Correct Coding and Coverage – E0740 Non-Implantable Pelvic Floor Electrical StimulatorCorrect Coding – Bemer Physical Vascular Therapy DevicesCorrect Coding – Weightless WalkerCorrect Coding - Cast CoversCorrect Coding – Fitness Monitoring TechnologiesCorrect Coding – Integrated Respiratory ProductsHCPCS Code Update - 2015Policy Article Revision – Vacuum Erection Devices (VED)Correct Coding – Oral Anticancer Drugs and PDAC’S NDC/HCPCS Crosswalk ListingsRetired – Correct Coding – Cefaly®Irrigation Supply Sleeves - Correct CodingCorrect Coding – Vibration Therapy DevicesCorrect Coding - ApniCure Winx® Sleep Therapy SystemCoding Guideline – K0900 (Custom Durable Medical Equipment, Other Than Wheelchairs)Breathe NIOV™ - Coding Reminder – Revised January 2014Correct Coding – Supplies Used With E0446 – Joint DME MAC PublicationCorrect Coding and Billing of Cantilever Type ArmrestTranscutaneous Electrical Nerve Stimulators (TENS) Sold Over-the-Counter – Coding GuidelinesOral Anti-Cancer Drugs – Coding and Billing ChangeHCPCS Code L0430 - InvalidCorrect Coding for Oral Appliances for the Treatment of Obstructive Sleep Apnea (E0486)Correct Coding and Billing of Halo ProcedurePDAC Code Verification Reviews for CGM Devices - Coding and BillingContinuous Glucose Monitors - Correct Coding and Billing - RevisedRetired - Continuous Glucose Monitors - Correct Coding and BillingCode Verification Review Requirement for Lower Limb Orthoses (L1832, L1833, and L1851) and Lumbar Sacral Orthoses (L0648 and L0650)Upper Limb Prostheses - Correct CodingConcentric Adjustable Torsion Joints – Correct CodingCorrect Coding – Safety Equipment Packages with Power Operated Vehicles (POVs)Correct Coding – L0174 Coding ReviewBilling for Capecitabine (Xeloda®) 500 MG Dosage Form – European Formulation Blister PackCorrection – New Modifier CS – Effective Date April 20, 2010Requirements for Coding Review of Custom Fabricated Spinal OrthosesCoding Guidelines for Therapeutic Shoes for Persons with DiabetesExercise Equipment - Correct CodingHCPCS Code A9283 - Devices Used for Edema or Ulcer HealingWhat is the Difference Between the PDAC and the DME MACS?Multiple Copies of Applications Not NeededE0486 – Custom Fabricated Oral Appliance for OSA – Coding and Utilization GuidelinesRetired - Respiratory Assist Devices – E0472Retired - New Off-the-Shelf Orthotic CodesRetired - Correct Coding – Drugs and FluidsCorrect Coding of Continuous Passive Motion DevicesHCPCS Code Update – 2011HCPCS Code Update - 2010 - RevisedHeight Standards for Coding LSO and TLSO - Revised2022 HCPCS Code Update - April Edition - Correct Coding - Revised