Noridian Administrative Services (NAS), the Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Review Department has completed a prepayment review of the Healthcare Common Procedure Coding System (HCPCS) code L-8030 and reported that of 95 claims reviewed, 68 were denied, resulting in a 76 percent error rate.
Primary documentation errors that resulted in denial of claims are:
- No office notes or medical records to support medical necessity were submitted: 22 percent
- Documentation submitted did not support medical necessity for the item requested: 19 percent
- Invalid proof of delivery: 17 percent
- No documentation received: 14 percent
Because of the high error rate, NAS said it will begin a widespread targeted review on HCPCS code L-8030.
NAS has also suggested that suppliers familiarize themselves with the documentation requirements and utilization parameters as outlined in the External Breast Prostheses Local Coverage Determination (LCD) L11569 and Policy Article A19833.
