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Medical Record Review Notifications and Results

Service Specific Post-Payment Reviews - Noridian has no current active Post-Payment Reviews.

Service Specific Pre-Payment Reviews - Noridian reviews used to determine the extent of potential problem areas across multiple suppliers and monitor corrective action measures implemented to reduce improper payments.

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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

65%

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

99%

L4361: WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF

72%

 

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

90%

 

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

80%

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 68%  
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    

 

External Infusion Pumps

Review Criteria Current Error Rate Service Specific Review Notification Current Review Results
E0784: EXTERNAL AMBULATORY INFUSION PUMP, INSULIN    
J1817: INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS    
J2260: INJECTION, MILRINONE LACTATE, 5 MG 66%  

 

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

87%

 

Immunosuppressive Drugs

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

J7507: TACROLIMUS, IMMEDIATE RELEASE, ORAL, 1 MG

54%

J7517: MYCOPHENOLATE MOFETIL, ORAL, 250 MG

58%

J7518: MYCOPHENOLIC ACID, ORAL, 180 MG

56%

 

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

100%

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

91%

 

Manual Wheelchairs

Review Criteria Current Error Rate Service Specific Review Notification Current Review Results
K0001: STANDARD WHEELCHAIR

84%

K0003: LIGHTWEIGHT WHEELCHAIR

90%

 

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

34%

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

37%

 

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

68%

E1390: OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE

68%

 

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

89%

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

95%

 

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)

73%

E0636: MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT ACCESSIBLE CONTROLS

   

 

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

40%

 

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

57%

 

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

86%

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

91%

LO: L0625, L0626, L0627, L0641, L0642

 

 

LSO: L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0643, L0648, L0649, L0650, L0651

 

 

SO: L0621, L0623

 

 

TLSO: L0450, L0452, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492

 

 

 

Surgical Dressings

Review Criteria Current Error Rate Service Specific Review Notification Current Review Results
A6021: COLLAGEN DRESSING, STERILE, SIZE 16 SQ. IN. OR LESS, EACH 93%  
A6212: FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING 96%  

 

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

91%

 

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

53%

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

62%

A4353: INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES

80%

 

Last Updated Jul 12, 2017