Region 5 RAC Audits for Spinal Orthoses

Performant Recovery, the Region 5 national Recovery Audit Contractor (RAC) for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and home health/hospice services, announced that it is initiating a post-payment complex medical claims review for complex spinal orthoses. Documentation will be reviewed to determine if spinal orthoses meet Medicare coverage criteria and/or are medically reasonable and necessary. The affected codes are L-0452, L-0480, L-0482, L-0484, L-0486, L-0629, L-0632, L-0634, L-0636, L-0638, L-0640, and A-9270. Claims having a claim paid date that is more than three years prior to the additional documentation request letter will be excluded.