NHIC, the Jurisdiction A Durable Medical Equipment Medicare Administration Contractor (DME MAC A) announced that it will be initiating a widespread prepayment probe of claims for lumbar sacral orthoses with HCPCS codes L0631 and L0637 as a result of a high volume of claim errors identified by the Comprehensive Error Rate Testing contractor.
Suppliers will be sent a documentation request, which must be returned within 45 days of the date of the letter. Requested documentation should include but is not limited to the physician order for the item, information from the medical record that demonstrates reasonable and necessary coverage criteria for the items are met, proof of delivery and an invoice for the item provided.
For more information on local coverage determination for spinal orthoses, visit www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin_pca/032213_lso.pdf.
