Article Detail - JA DME

Suppliers have often asked how to best determine the usual maximum quantity of certain urological supplies the beneficiary may receive within a month. Local Coverage Determination (LCD) L33803 lists the most frequently used codes and the amount typically considered reasonable and necessary for a beneficiary in a given month. The explanation for use of a supply quantity greater than the amount listed must be clearly documented in the beneficiary's medical record. If adequate documentation is not provided when requested, the excess quantity will be denied as not reasonable and necessary.