The related Policy Article for the Ankle-Foot Orthosis/Knee-Ankle-Foot Orthosis is being revised. The Policy Article with an effective date of January 1, 2013 included Coding Guidelines for AFOs that included a height requirement. The height requirement is being removed. The… Read More ›
DME Coding 
OIG Calls for Cuts in Medicare Rates for Back Orthoses
The OIG is calling on CMS to lower Medicare payment for certain back orthosis products, either by subjecting these products to the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program or by making an inherent reasonableness… Read More ›
HCPCS Code L0430 – Invalid
Effective for dates of service on or after November 17, 2012, Healthcare Common Procedure Coding System (HCPCS) code L0430 (SPINAL ORTHOSIS, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH INTERFACE MATERIAL, CUSTOM FITTED (DEWALL POSTURE PROTECTOR ONLY)) will be invalid for claim submission to the… Read More ›
Results of Widespread Prepayment Probe Review of Ankle-Foot/Knee-Ankle-Foot Orthosis (HCPCS L4360, L1970 and L1960)
Review Results Jurisdiction D DME MAC Medical Review Department completed a widespread prepayment probe review of HCPCS codes L4360, L1970 and L1960. This review was initiated based on CERT analysis. The L4360 review involved 101 claims of which 97 were… Read More ›
NOTIFICATION OF PREPAYMENT REVIEW FOR ORTHOTIC AND PROSTHETIC HCPCS CODES
NAS Jurisdiction D DME MAC Medical Review will be initiating a widespread prepayment probe review of claims for each of the following HCPCS codes: L0631, L0637, L0830, L4360, L1960, and L1970. This review is being initiated based on the results of Comprehensive Error Rate Testing (CERT)… Read More ›
Effective July 1, 2012: Local Coverage Determination (LCD) for Knee Orthoses (L27263)
Medicare Approves An Addition Code for Custom Knee Bracing. For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or… Read More ›
New Tools to Fight Fraud, Strengthen Federal Health Programs, and Protect Taxpayer Dollars
The Affordable Care Act takes historic steps toward combating health care fraud, waste and abuse by providing critical new tools to crack down on entities and individuals attempting to defraud Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and private… Read More ›
Product Labeling Requirements Rescinded – Effective Immediately
PDAC has rescinded the requirements for product labeling as outlined in the article titled Product Labeling and Product Sample Requirements for Coding Verification that was posted to the PDAC website on September 22, 2011 and the revision article posted on… Read More ›
CODING GUIDELINES FOR ANKLE FOOT ORTHOSES
Recently the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and the Pricing Data Analysis & Coding (PDAC) contractor received questions regarding coding guidelines for Ankle Foot Orthosis. In an effort to address these questions, the following definitions for certain… Read More ›
Reminder: Start Using the Revised CMS-855S Enrollment Application
DMEPOS suppliers are reminded that the CMS-855S enrollment application was recently revised to capture additional information pertinent for enrollment processing. Suppliers should use the CMS-855S version (07/11) if enrolling in Medicare for the first time, reporting changes to existing enrollment,… Read More ›
