Thanks to advocacy from the Alliance of Wound Care Stakeholders, and as a result of the successful case United States District Court, District of Columbia decision in Greenwald v. Becerra (Decided June 7, 2022), the DMEMACs released an updated Local Coverage Determination (LCD) revision that eliminates the requirement of serial four week trials of conservative therapy in order to obtain a Pneumatic Compression Device (PCD). It also eliminated the language regarding “no significant improvement” since that was very difficult to define and presented a barrier to access.
You can also click on the link below to see it on the Noridian website:
LCD Revisions Summary for July 13, 2023
Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) that has been revised and posted. The policy included is Pneumatic Compression Devices. Please review the entire LCD and related Policy Article (PA) for complete information.
Pneumatic Compression Devices
LCD
Revision Effective Date: 06/07/2022
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: “At the end of the four-week trial, if there has been improvement, then reimbursement for a PCD is not justified. Where improvement has occurred, the trial of conservative therapy must be continued with subsequent reassessment at intervals at least a week apart. Only when no significant improvement has occurred in the most recent four weeks and the coverage criteria above are still met, may the lymphedema be considered unresponsive to conservative therapy, and coverage for a PCD considered.”
Removed: “At a minimum, re-assessments conducted for a trial must include detailed measurements, obtained in the same manner and with reference to the same anatomic landmarks, prior to and at the conclusion of the various trials and therapy, with bilateral comparisons where appropriate.”
07/13/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates based on CMS direction as a result of the United States District Court, District of Columbia decision in Greenwald v. Becerra (Decided June 7, 2022)
Caroline
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
