Same or Similar Chart - JA DME
Same or Similar Chart
Prior to providing a new item, and to gain the necessary information required (has there been a change in beneficiary's medical condition that supports need for a different type of similar item or if it has been lost, stolen, or irreparably damaged) to determine whether an Advance Beneficiary Notice of Noncoverage (ABN) should be obtained or not, it is best to:
- Verify that a beneficiary has/has not had a same or similar item
- If he/she has not, bill claim without ABN (no ABN is necessary)
- If he/she has, determine if item has reached its specific reasonable useful lifetime (RUL)
- If it has, bill claim without ABN (no ABN is necessary)
- If it has not, obtain an ABN and bill claim with applicable modifier
Verification options include:
- Ask beneficiary
- Check via Noridian Interactive Voice Response (IVR)
- Access such information within Noridian Medicare Portal (NMP)
If there is any reason to believe that a beneficiary may have obtained a same or similar item outside of Jurisdiction A, check with the other jurisdictions (B, C, and D) as well.
- Same or Similar: How to Avoid Denial
- Same or Similar Denials
- Same or Similar and Advance Beneficiary Notice of Noncoverage (ABN) Documentation
- Reasonable Useful Lifetime Clarification
- Reasonable Useful Lifetime and Duplicate Items - Billing Reminder
The list is NOT all inclusive and that while every effort is made to keep it current, there may be relationships that might trigger a denial that are not listed.
Item | Item Type | Same HCPCS Category | Similar HCPCS Category |
---|---|---|---|
AFO/KAFO | O&P | L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2106, L2108, L2112, L2114, L2116, L2126, L2128, L2132, L2134, L2136, L4350, L4360, L4361, L4370, L4386, L4387, L4396, L4397, L4398, L4631 | |
Bed Side Rails | DME | E0305, E0310 | Hospital Beds with Rails E0250, E0251, E0328, E0255, E0256, E0260, E0261, E0329, E0265, E0266, E0301, E0302, E0303, E0304 |
Blood Glucose Monitors | DME | E0607, E2100, E2101 | |
Continuous Glucose Monitors | DME | K0554, E2102 | E0607, E2100, E2101 |
Canes and Crutches | DME | E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116 | |
Commodes | DME | E0163, E0164, E0165, E0166, E0168, E0169, E0170, E0171 | |
External Breast Prosthesis | O&P | L8015, L8020, L8030, L8031, L8032, L8035, L8039 | |
Functional Electrical Stimulator | DME | E0764, E0770 | E0720, E0730, A4595 |
Heat Lamps | DME | E0200, E0205 | |
Heat Pads | DME | E0210, E0215, E0217, E0220, E0221, E0225, E0236, E0238, E0239 | |
High Frequency Chest Wall Oscillation Devices | DME | E0483 | E0480, E0482 |
Hospital Beds | DME | E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0301, E0302, E0303, E0304, E0328, E0329 | |
Humidifiers Note: When used with a positive airway pressure (PAP) device |
DME | E0561, E0562 | |
Infusion Pumps | DME | E0779, E0780, E0781, E0791 | |
Knee Orthoses | O&P | L1810, L1812, L1820, L1830, L1831, L1832, L1833, L1834, L1836, L1840, L1843, L1844, L1845, L1846, L1847, L1848, L1850, L1851, L1852, L1860 | |
Manual Wheelchairs | DME | E1031, E1037, E1038, E1039, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009 | Canes and Crutches E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116 Walkers E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149 |
Mechanical In-exsufflation Devices | DME | E0482 | E0480, E0483 |
Nebulizers and Compressors | DME | E0565, E0570, E0571, E0572, E0574, E0575, E0580, E0585 | |
NEMS | DME | A4595 | E0720, E0730, E0764, E0770 |
Oxygen Contents (Portable) | DME | E0443, E0444 | |
Oxygen Contents (Stationary) | DME | E0441, E0442 | |
Oxygen, Portable Equipment | DME | E0430, E0431, E0433, E0434, E0435, E1392, K0738 | |
Oxygen, Stationary Equipment | DME | E0424, E0425, E0439, E0440, E1353, E1390, E1391, E1405, E1406 | |
Parenteral Pumps | DME | B9004, B9006 | |
Patient Lifts | DME | E0630, E0635, E0636, E0639, E0640 | |
Patient Lifts | DME | E1035, E1036 | Canes and Crutches E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116, E0117, E0118 Walkers E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149 Patient Lifts E0630, E0635, E0636, E0639, E0640 |
Percussor | DME | E0480 | E0482, E0483 |
Pneumatic Appliances-Arm | DME | A4600, E0655, E0665, E0668, E0672 | |
Pneumatic Appliances-Leg | DME | A4600, E0660, E0666, E0667, E0669, E0671, E0673 | |
Pneumatic Compressors | DME | E0650, E0651, E0652, E0676 | |
Pneumatic Compressor Leg Appliances | DME | E0660, E0666, E0667, E0669, E0670, E0671, E0673, E0676 | |
Pneumatic Compressors Arm Appliances | DME | E0655, E0665, E0668, E0672, E0676 | |
Pneumatic Compressors Trunk Appliances | DME | E0656, E0657, E0670, E0676 | |
Power Wheelchairs | DME | E1035, E1036, E1230, K0013, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898 | Manual Wheelchairs E1031, E1037, E1038, E1039, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009 Walkers E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149 Canes and Crutches E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116, E0117, E0118 |
Respiratory Assist Devices | DME | E0450, E0454, E0460, E0461, E0463, E0464, E0465, E0466, E0470, E0471, E0472, E0601 | |
Seat Lift Mechanisms | DME | E0627, E0628, E0629 | |
Speech Generating Devices | DME | E2500, E2502, E2504, E2506, E2508, E2510, E2511 | |
Spinal Orthoses - Lumbar Sacral Orthoses | O&P | L0450, L0452, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492, L0621, L0622, L0623, L0624, L0625, L0626, L0627, L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0641, L0642, L0643, L0648, L0649, L0650, L0651 | |
Stimulators | DME | E0747, E0760 | |
Support Surfaces | DME | E0181, E0182, E0184, E0185, E0186, E0187, E0188, E0189, E0193, E0194, E0196, E0197, E0198, E0199, E0277, E0371, E0372, E0373 | |
Therapeutic Shoes for Persons with Diabetes | O&P | A5500, A5501 | |
Traction Frames | DME | E0840, E0850, E0855, E0856, E0860, E0947, E0849 | |
Transcutaneous, Electrical Nerve Stimulators (TENS) | DME | E0720, E0730 | E0764, E0770, A4595 |
Trapeze Bars | DME | E0910, E0911, E0912, E0940 | |
Ventilators | DME | E0465, E0466, E0467 | |
Walkers | DME | E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149 | Canes and Crutches E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116, E0117, E0118 |
Wheelchair Back Cushions | DME | E2611, E2612, E2613, E2614, E2615, E2616, E2617, E2620, E2621 | |
Wheelchair Seat Cushions | DME | E2601, E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2609, E2610, E2622, E2623, E2624, E2625, K0734, K0735, K0736, K0737 |
Last Updated Thu, 05 May 2022 19:49:59 +0000