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Complex Review Notifications and Results

Service Specific Post-Payment Reviews - Noridian DME Medical Review currently does not have any active Post-Payment Reviews.

Service Specific Pre-Payment Reviews - Service Specific Pre-Pay Reviews conducted by Noridian DME Medical Review are used to determine the extent of potential problem areas across multiple suppliers and monitor corrective action measures implemented to reduce improper payments.

Ankle Foot/Knee-Ankle-Foot Orthosis

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

L1970: ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED

 

 

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    

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Diabetic Supplies

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

A4253: BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50 STRIPS

 

 

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Enteral Nutrition

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

B4035: ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE

 

 

B4150: ENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT    
B4154: ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS, EXCLUDES INHERITED DISEASE OF METABOLISM, INCLUDES ALTERED COMPOSITION OF PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND/OR MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT    

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Hospital Beds

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

E0260: HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE RAILS, WITH MATTRESS

 

 

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Immunosuppressive Drugs 

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

J7507: TACROLIMUS, IMMEDIATE RELEASE, ORAL, 1 MG

 

 

J7517: MYCOPHENOLATE MOFETIL, ORAL, 250 MG  

 

J7518: MYCOPHENOLIC ACID, ORAL, 180 MG  

 

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Knee Orthosis

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

L1832: KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID SUPPORT, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE

 

 

L1833: KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID SUPPORT, PREFABRICATED, OFF-THE SHELF

 

 

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Manual Wheelchairs

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

K0001: STANDARD WHEELCHAIR

 

 

K0003: LIGHTWEIGHT WHEELCHAIR

 

 

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Nebulizers

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

J7605: ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS
  • 47%

J7626: BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG Additional Search Terminology:  PULMICORT , PULMICORT RESPULES

  • 48%

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Oxygen and Oxygen Equipment

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

E0431: PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR MASK, AND TUBING
  • 71%
E1390: OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE
  • 66%

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Parenteral Nutrtition

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

B4197: PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, 74 TO 100 GRAMS OF PROTEIN - PREMIX  

 

B4199: PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, OVER 100 GRAMS OF PROTEIN - PREMIX    

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Patient Lifts

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

E0630: PATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD(S)

 

 

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Positive Airway Pressure (PAP) Devices 

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

E0601: CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE. FIRST MONTH OF BILLING

48%

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Pressure Reducing Support Surfaces (PRSS) Group 2

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

E0277: POWERED PRESSURE-REDUCING AIR MATTRESS

 

 

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Spinal Orthoses: TLSO and LSO

Review Criteria Current Error Rate Service Specific Review Notification Current Review Results

L0648: LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, OFF-THE-SHELF

 

 

L0650: LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANEL(S), PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, OFF-THE-SHELF

 

 

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Therapeutic Shoes and Inserts

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

A5500: FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND SUPPLY OF OFF-THE-SHELF DEPTH-INLAY SHOE MANUFACTURED TO ACCOMMODATE MULTI- DENSITY INSERT(S), PER SHOE

 

 

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Urological Supplies

Review Criteria

Current Error Rate

Service Specific Review Notification

Current Review Results

A4351: INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH

 

 

A4352: INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH

 

 

A4353: INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES    

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Last Updated Jan 17, 2017