The medical review department at Noridian, the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC), released quarterly results of its Targeted Probe and Educate pre-payment reviews of AFOs, knee and spinal orthoses, and therapeutic shoes. The reviews were conducted in April through June.
Based on dollars, the overall claim potential improper payment rate for AFO Healthcare Common Procedure Coding System (HCPCS) codes L-1970, L-1971, L-4360 and L-4361 was 15 percent. The rate in January through March was 32 percent.
Based on dollars, the overall claim potential improper payment rate for knee orthoses HCPCS codes L-1832, L-1833, L-1843 and L-1851 was 63 percent. The rate in January through March was 44 percent.
Based on dollars, the overall claim potential improper payment rate for spinal orthoses HCPCS codes L-0627, L-0631, L-0637, L-0642, L-0648 and L-0650 was 35 percent. The results from January through March was 24 percent.
Based on dollars, the overall claim potential improper payment rate for therapeutic shoes HCPCS code A-5500 was 52 percent. The rate in January through March was 64 percent.
