On July 10, Noridian Administrative Services (NAS), the Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor (DME MAC), announced that it will be initiating a prepayment probe review of claims for the following Healthcare Common Procedure Coding System (HCPCS) codes.
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L-0631 (lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment)
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L-0637 (lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting & adjustment)
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L-8030 (breast prosthesis, silicone or equal, without integral adhesive)
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L-4360 (walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, includes fitting & adjustment)
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L-1960 (ankle-foot orthosis, posterior solid ankle, plastic, custom fabricated)
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L-1970 (ankle-foot orthosis, plastic with ankle joint, custom fabricated)
According to NAS, all suppliers billing Jurisdiction D for these HCPCS codes 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.
