Article Detail - JD DME
New Knee Orthosis Codes Require Coding Verification Review (CVR) October 10, 2022
The only products which may be billed using the following list of HCPCS codes are those for which a written CVR has been made by the PDAC contractor and published on their Product Classification List (PCL). Information concerning the documentation that must be submitted for a CVR can be found on the PDAC website by selecting the Topics dropdown menu, then Coding Verification; or by contacting PDAC. Products which have received a coding verification can be found on the PDAC web site by first selecting the DMECS tile, then the Product Classification List bubble. The effective date of the CVR is included for each code.
Required CVR effective dates:
- Effective for claims with dates of service on or after July 01, 2008: Knee orthosis L1845
- Effective for claims with dates of service on or after January 1, 2017: Knee orthosis L1852
- Effective for claims with dates of service on or after October 10, 2022: Knee orthoses L1832, L1833, and L1851
- Effective for claims with dates of service on or after July 1, 2010: Spinal orthoses L0450, L0454, L0456, L0458, L0460, L0462, L0464, L0466, L0468, L0470, L0472, L0488, L0490, L0491, L0492, L0625, L0626, L0627, L0628, L0630, L0631, L0633, L0635, L0637, L0639
- Effective for claims with dates of service on or after January 1, 2014: Spinal orthoses L0455, L0457, L0467, L0469, L0641, L0642, L0643, L0648, L0649, L0650, L0651
If a product is billed to Medicare using a HCPCS code that requires a written CVR, but the product is not on the PCL for that particular HCPCS code, the claim line will be denied as incorrect coding.