Urological Supplies (HCPCS A4352 & A4353) Final Edit Effectiveness Results of Service Specific Post-Payment Review - JD DME
Urological Supplies (HCPCS A4352 & A4353) Final Edit Effectiveness Results of Service Specific Post-Payment Review
The Jurisdiction D, DME MAC, Medical Review Department is conducting a post-payment service specific review of HCPCS codes A4352 and A4353. The final edit effectiveness results from September 2021 through November 2021 are as follows.
Based on dollars, the overall claim potential improper payment rate is 58% for HCPCS A4352.
Based on dollars, the overall claim potential improper payment rate is 44% for HCPCS A4353.
Top Denial Reasons
- Documentation was not received in response to the Post-Payment Notification Letter.
- Documentation does not support coverage criteria.
- The documentation was not timely (within the preceding 12 months) to support continued need by the beneficiary.
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Urological Supplies 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 Fri, 14 Jan 2022 13:40:45 +0000