Ankle-Foot Orthosis (AFO) (HCPCS L4360 and L4361) Notification of Service Specific Post-Payment Review

Noridian Jurisdiction A, DME MAC, Medical Review is initiating service specific post-payment medical record review of claims for the following HCPCS codes:

  • L4360: WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE
  • L4361: WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF

Service specific reviews are initiated to prevent improper payments for services which present possible sustained or high-level payment errors. This review is being initiated based on data analysis identifying probable vulnerabilities. Please see the Medical Record Review Results page for further information.

            Last Updated Mon, 07 Dec 2020 14:30:10 +0000