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Home News

Latest Noridian Review Results Released

by The O&P EDGE
July 6, 2021
in News
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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.

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  3. Jurisdiction A Posts Quarterly Service-specific Prepayment Review Results for Orthoses, Therapeutic Shoes
  4. New Medicare Rules Take Effect for O&P Care
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