CGS, the Jurisdiction B and C Durable Medical Equipment Medicare Administrative Contractor, will conduct a prepayment medical record review of claims submitted by new suppliers for lower-limb, upper-limb, and spinal orthoses and diabetic shoes.
CGS said the policy groups, along with four non-O&P supplies, ranked high in Comprehensive Error Rate Testing. The Centers for Medicare & Medicaid Services identified new suppliers through the 2026 Home Health Prospective Payment System and the Nationwide Temporary Moratoria on Enrollment of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Medical Supply Companies as often associated with high levels of fraud, waste, and abuse.
CGS will send additional documentation requests to request the following information to support payment of the claim:
- Treating practitioner’s written order
- Relevant medical records that support the item(s) that is prescribed are medically necessary
- Any other pertinent documentation
- Proof of delivery
- Copy of Advance Beneficiary Notice if one was obtained
