DME MACs Local Coverage Determination (LCD) Format Change

If you are a supplier that dispenses DMEPOS to Medicare beneficiaries, then you know Medicare requires certain documentation to meet coverage criteria. This coverage criterion is necessary to determine if DME is reasonable and necessary for each beneficiary.

The requirements are located in every LCD on each jurisdiction’s website. In 2011, the DME MACs added the DOCUMENTATION REQUIREMENTS section because of the frequency at which providers were supplying incomplete or missing documentation, needed to determine medical necessity for each beneficiary and lower the improper payment rate. Since this time, minor changes within these requirements have required a tremendous effort and administrative burden to keep each LCD updated.

In a recent Joint DME MAC Publication, CMS said it will be changing the format of these LCDs during their annual LCD review. The GENERAL DOCUMENTATION REQUIREMENTS section for all LCDs will be moved to their related Policy Article for reference. The GENERAL DOCUMENTATION REQUIREMENTS section contains standardized requirements, which provide detailed information on each key payment rule. In addition, the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS section, which also appears within each LCD, will be moved to their respective Policy Article. The POLICY SPECIFIC DOCUMENTATION REQUIREMENTS section contains coverage criteria specific to that piece of DME, which is required for payment purposes.

These changes will take place in early January 2017 and will not add any new or remove any existing Medicare documentation requirements. When these changes are implemented, you will need to access all three documents: the LCD, the Policy Article and the new Standard Documentation Requirements.