LCD Reference Article Response To Comments Article

Response to Comments: Enteral Nutrition - DL38955

A59397

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Article ID
A59397
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Article Title
Response to Comments: Enteral Nutrition - DL38955
Article Type
Response to Comments
Original Effective Date
05/18/2023
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During the 45-day comment period, which was open from February 9, 2023 through March 25, 2023, the DME MACs received comments from one commenter.

 

NOTE: DME MACs review all submitted comments and may choose to consolidate similar thematic comments or redact or withhold certain submissions (or portions thereof) such as those containing private or proprietary information, inappropriate language or duplicate/near duplicate submissions. As a result, there may be a discrepancy between the number of comments in the article and the actual number of comments received.

 

Introduction to Responses

The DME MACs appreciate the comments received from stakeholders during the open comment period for the proposed Enteral Nutrition Local Coverage Determination (LCD) (DL38955).

Response To Comments

Number Comment Response
1

One commenter expressed their support of the revisions to the Enteral Nutrition LCD to include the use of the KX, GA, GY, and GZ modifiers to facilitate claims processing and assist in preventing improper claims payments. Additionally, they requested that if a supplier receives a CO denial that states, “the procedure code is inconsistent with the modifier used or a required modifier is missing,” that the MAC be willing to share details regarding the modifier issue that led to the denial. They also requested education to suppliers if there comes a time that modifiers are required to be reported in a specific order.

The DME MAC Medical Directors would like to thank the individual and their association for submitting detailed comments and offering support for the revisions in the proposed Enteral Nutrition LCD. Although the additional suggestions will not result in updates to the Enteral Nutrition LCD, the DME MACs are sensitive to the feedback. At this time, Medicare does not require a specific order of modifiers on the CMS-1500 claim form or electronic equivalent. Should Medicare implement such a requirement in the future, the DME MACs will consider options for supplier education.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L38955 - Enteral Nutrition
Related National Coverage Documents
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Updated On Effective Dates Status
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