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Same or Similar Reference Chart

The below chart has been created to assist suppliers in understanding same or similar denials. 

Suppliers should use the IVR or the Noridian Medicare Portal to verify that a beneficiary has not had a same or similar item within the previous five years. If a beneficiary has had any piece of equipment from the same DMEPOS item category within the previous five years, a same or similar denial can be expected.

DME suppliers are expected to be familiar with DME coverage policies and any additional pertinent information that may have an impact on medical necessity determinations. In order to be protected under the limitation of liability provision, a supplier must provide a proper ABN for each item that it believes is likely to be denied as not medically necessary.

DMEPOS Item HCPCS
Apnea Monitor E0618
Bed Side Rails E0305, E0310
Blood Glucose Monitors E0607, E2100, E2101
Canes E0100, E0105
Commodes E0163, E0164, E0165, E0166 , E0168, E0169, E0170, E0171
Compressor/Nebulizer NOTE: When used with Intermittent Positive Pressure Breathing (IPPB) treatments or oxygen delivery E0565, E0572, E0575, E0585
Crutches E0110, E0111, E0112, E0113 , E0114, E0116, E0117, E0118
Cushions E0176, E0177, E0178, E0179 , E0962, E0963, E0964, E0965, E2601, E2602, E2603, E2604 , E2605, E2606, E2607, E2608, E2609, E2610, E2622 , E2623, E2624, E2625, K0734, K0735, K0736, K0737
Enteral Formula B4149 B4150 B4152 B4153 B4154 B4155 B4157 B4158 B4159 B4160 B4161 B4162
Enteral Pumps B9000 B9002
Heat Lamps E0200, E0205
Heat Pads E0210, E0215, E0217, E0220 , E0221, E0225, E0236, E0238, E0239
High Frequency Chest Wall Oscillation Devices E0480, E0482, E0483
Hospital Beds 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 E0561, E0562, K0268, K0531
Infusion Pumps E0779, E0780, E0781, E0784 , E0791
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
Mechanical In-exsufflation Devices E0480, E0482, E0483
Nebulizers and Compressors E0570, E0571, E0574, E0580
Oxygen Contents (Portable) E0443, E0444
Oxygen Contents (Stationary) E0441, E0442
Patient Lifts E0625, E0630, E0635, E0639, E0640
Parenteral Nutrition B4164 B4180
Parenteral Nutrition B4168 B4172 B4176 B4178 B4189 B4199 B5000 B5100 B5200
Parenteral Nutrition B4184, B4186, B4193, B4197
Parenteral Pumps B9004 B9006
Percussors E0480, E0482
Pneumatic Appliances-Arm A4600, E0655, E0665, E0668 , E0672
Pneumatic Appliances-Leg A4600, E0660, E0666, E0667 , E0669, E0671, E0673
Pneumatic Compressors E0650, E0651, E0652, E0656, E0657, E0670
Portable Oxygen, Equipment E0430, E0431, E0433, E0434, E0435 , E1392, K0738
Power Wheelchairs E1035, E1036, E1230, K0010 , K0011, K0012, K0013, K0014, 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, K0899
Respiratory Assist Devices E0450, E0454, E0460, E0461 , E0470, E0471, E0601
Seat Lift Mechanisms E0627, E0628, E0629
Stationary Oxygen, Equipment E0424, E0425, E0439, E0440 , E1353, E1390, E1391, E1405, E1406
Stimulators E0747, E0760
Speech Generating Devices E2500, E2502, E2504, E2506 , E2508, E2510, E2511
Support Surfaces E0181, E0182, E0184 , E0185, E0186, E0187, E0188, E0189, E0193, E0194, E0196, E0197 , E0198, E0199, E0277, E0371, E0372, E0373
Traction Frames E0840, E0850, E0855, E0856 , E0860, E0947, E0849
Trapeze Bars E0910, E0911, E0912, E0940
Transcutaneous, Electrical Nerve Stimulators (TENS) E0720, E0730
Walkers E0130, E0135, E0140, E0141 , E0143, E0144, E0147, E0148, E0149
Wheelchair Back Cushions E2611, E2612, E2613, E2614 , E2615, E2616, E2617, E2620, E2621
Wound Therapy E2402

 

The Same and Similar Reference Chart content was last updated August 13, 2014.

Last Updated Jan 16, 2017