Same or Similar Chart
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.
To avoid a same or similar denial, suppliers should use the Interactive Voice Response (IVR) or Noridian Medicare Portal (NMP) to verify that a beneficiary has not had a same or similar item within the previous five years or specific reasonable useful lifetime (RUL) for the item.
- 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
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| 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 | 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 | K0901, K0902, 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 Walkers |
| Mechanical In-exsufflation Devices | DME | E0467, E0482 | E0480, E0483 |
| Multifunction Ventilator | DME | A4216, A4217, A4604, A4605, A4619, A4628, A7000, A7001, A7002, A7003, A7004, A7005, A7006, A7007, A7012, A7013, A7014, A7015, A7017, A7020, A7025, A7026, A7027, A7028, A7029, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, A7047, A7525, E0424, E0431, E0433, E0434, E0439, E0441, E0442, E0443, E0444, E0447, E0465, E0466, E0467, E0470, E0471, E0472, E0482, E0483, E0484, E0561, E0562, E0565, E0570, E0572, E0585, E0600, E0601, E1372, E1390, E1391, E1392, E1405, E1406, K0738 | E0486 |
| Nebulizers and Compressors | DME | E0467, 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, E0467, 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 Walkers Patient Lifts |
| 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 Walkers Canes and Crutches |
| Respiratory Assist Devices | DME | E0450, E0454, E0460, E0461, E0463, E0464, E0465, E0466, E0467, 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 May 06, 2019