Article Detail - JA DME
Attention Competitive Bid Suppliers Furnishing Off-the-Shelf (OTS) Knee and Back Braces as a Non-Contract Physician or Other Treating Practitioner, Physical Therapist, or Occupational Therapist
Competitive bid non-contract physicians, other treating practitioners, physical therapists, and occupational therapists are receiving denials when there is no Part B practitioner claim on file with the same date of service as the claim for DME they provided and billed. Reason Code B15 and Remark Code M114 is the denial received on the remittance advice for this denial.
To resolve the denial:
- Ensure Part B practitioner claim has processed and paid prior to appealing
- A redetermination request may be submitted with all relevant supporting documentation
- Noridian encourages redeterminations/appeals be submitted using the Noridian Medicare Portal
- Review applicable Competitive Bidding requirements prior to submitting request
- The OTS back brace or OTS knee brace must be furnished by the physician/ treating practitioner to their own patient as part of their professional service.
- Must be office visit, surgery is not included
- Claims must have same date of service as the professional office visit or physical/occupational therapy service billed to the Part B MAC
- The billable office visit is an absolute requirement
- Brace must be medically necessary to be worn at home prior to surgery
- If medical need does not exist until after surgery, a competitive bid contractor must supply brace
Last Updated Mon, 20 Mar 2023 16:38:48 +0000