The Medical Review Department at Noridian, the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC), released March through May results of its post-payment service-specific review of knee orthosis and AFO codes.
Based on dollars, the overall claim potential improper payment rate for knee orthosis Healthcare Common Procedure Coding System (HCPCS) code L-1833 was 78 percent, and 79 percent for L-1851.
Based on dollars, the overall claim potential improper payment rate for AFO HCPCS code L-4360 was 84 percent, and 42 percent for L-4361.
The top denial reasons were that documentation was not received in response to the post-payment notification letter, the documentation did not support coverage criteria, or that no medical record documentation was received.
