Article Detail - JA DME

Suppliers have often asked how to best determine the usual maximum quantity of certain ostomy supplies the beneficiary may receive within a month. Local Coverage Determination (LCD) L33828 has an extensive list of the most frequently used codes and how many are typically considered reasonable and necessary for a beneficiary in a given month. The explanation for use of a supply quantity greater than the amounts listed must be clearly documented in the beneficiary’s medical record. If adequate documentation is not provided when requested, the excess quantities will be denied as not reasonable and necessary.