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) analysis and previous review results.  In order to evaluate compliance with Medicare coverage and coding rules, all suppliers billing Jurisdiction D for HCPCS codes listed above are subject to this review. Suppliers of the selected claims will receive an Additional Documentation Request (ADR) letter asking for specific information to determine if the item billed complies with the existing reasonable and necessary criteria. Failure to supply the requested information within 45 days of the date on the letter will result in the claim being denied. The ADR letter will provide instruction for submitting documentation.  Please click here for more information:  Noridian Notification