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David McGill Blogger

Changes to the Structure of all LCDs Coming

Posted by David McGill | January 05, 2017

​The DME MACs have issued a joint announcement in which they detail structural changes to all medical device LCD's. The stated reason for these changes is the difficulty in administering the LCDs in their current format. Here's what you need to know:

  1. ​​The DOCUMENTATION REQUIREMENTS section that appears at the beginning of all LCDs will be removed from each individual LCD and placed into a new, "Standard Documentation Requirements LCD related Policy Article."

  2. For those LCD's that currently include "POLICY SPECIFIC DOCUMENTATION REQUIREMENTS", those requirements will be deleted from the LCD and incorporated into the LCD's accompanying Policy Article.

What does this mean for you?

Information about coverage requirements will be more fragmented under this new approach than it is today. Currently, everything you need to know sits in two documents: (1) the LCD and (2) its accompanying Policy Article. You are responsible for knowing the information in both and satisfying all applicable requirements.

When the MACs implement these changes, the same information will now be split across three documents: (1) the LCD; (2) the Policy Article; and (3) the new "Standard Documentation Requirements" document. The transition is scheduled for "early 2017", so we would expect to see the changes no later then end of Q1.

Össur R&R will publish a new post when the MACs do this so that you are aware of it. When that happens, we recommend that you immediately visit your MAC's website and download all 3 documents. While there will not be any substantive differences as a result of these changes, you should always have the most current version of these documents in your possession.

To summarize: the LCD and Policy Article will no longer contain all the information you're responsible for knowing after the MACs implement these changes. You will additionally need to refer to the yet-to-be-created General Documentation Requirements document.

We will keep you posted as this situation continues to develop.

Össur R&R

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If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at reimbursement411@ossur.com