Termination of Parenteral Nutrition Local Coverage Determination & Related Policy Article with Correct Coding and Billing – November 12, 2020

The Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) have made the decision to retire the Parenteral Nutrition Local Coverage Determinations (LCDs) along with a related Policy Article. Due to the gradual development of the parenteral nutrition clinical paradigms. MACs are able to revise or retire their LCD’s at their own discretion, at any time as stated in the CMS Program Integrity Manual, Chapter 13, Section 13.3, (CMS Pub. 100-08). 

Any claims for Parenteral Nutrition with dates of service on or after November 12, 2020 will no longer be subject to the LCD (L33798) and Policy Article (A52515). Instead, providers must refer to the CMS National Coverage Determinations (NCD) Manual (CMS Pub. 100-03) Chapter 1, Section 180.2 – Enteral and Parenteral Nutritional Therapy – for additional information about the coverage criteria.  Any claims with dates prior to November 12, 2020 will still be subjected to the LCD and related policy article. 

Parenteral nutrition coverage is included under the Prosthetic Device benefit (Social Security Act § 1861(s)(8)). For claims with service dates on or after November 12, 2020 the beneficiary’s nutrition must meet the reasonable and necessary requirements from CMS NCD 180.2 for reimbursement eligibility. When ensuring the beneficiary’s coverage criteria is met, suppliers need to monitor the beneficiary’s parenteral nutrition. Once coverage is confirmed, medically necessary nutrients, administrative supplies, and equipment will be covered.

For a detailed list of exact coverage and billing requirements, please read the DME MAC article “Parenteral Nutrition – Correct Coding and Billing” https://med.noridianmedicare.com/web/jadme/policies/dmd-articles/2020/parenteral-nutrition-correct-coding-and-billing 

Noridian “Parenteral Nutrition – Correct Coding and Billing” article https://www.cgsmedicare.com/jb/pubs/news/2020/10/cope19138.html