Spinal Orthosis (HCPCS L0648 and L0650) Quarterly Edit Effectiveness Results of Service Specific Post-Payment Review

The Jurisdiction A, DME MAC, Medical Review Department is conducting a post-payment service specific review of HCPCS code(s) L0648 and L0650. The quarterly edit effectiveness results from April 2021 through June 2021 are as follows.

Based on dollars, the overall claim potential improper payment rate is 33% for HCPCS L0648.

Based on dollars, the overall claim potential improper payment rate is 69% for HCPCS L0650.

Top Denial Reasons

  • Documentation was not received in response to the post-payment notification letter.
  • Documentation does not support coverage criteria.
  • The item was provided during an inpatient hospital or Part A covered skilled nursing facility stay prior to the day of discharge and the use began during the stay.
  • Medical record documentation contains a practitioner’s signature which does not comply with the Centers for Medicare & Medicaid Services signature requirements.

Educational Resources

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Orthotics webpage to access coverage documents.

  • National Coverage Determination (NCD)
  • Local Coverage Determination (LCD)
  • Policy Article
  • Documentation letters, forms, and checklists
  • Review tips, tools, and resources
  • Related articles
  • Educational events and tutorials, if applicable

See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 for more information on medical record reviews.

 

Last Updated Thu, 29 Jul 2021 15:32:44 +0000