Liver Transplant Additional Development Requests (ADRs)

Due to Medicare Code Editor (MCE) errors, not all transplant claims were appropriately hitting for the limited coverage procedure codes or ordering the operative report. Noridian has adjusted these claims to appropriately order the operative report and verify the guidelines of coverage are met as outlined in National Coverage Determinations 260.1 or 260.2. More information on liver transplants can be found in Internet Only Manual (IOM) 100-04 Chapter 3 Section 90.4.

Noridian is posting this to address Provider concerns regarding additional development request 7ZA17 for limited coverage reason codes W1505 and W1506. Providers should send in the operative report supporting the covered conditions and diagnosis codes submitted on the claim. Please do NOT send the entire record/file as this will slow down the process.

Files sent in that are extremely large in size will be returned to the provider.

Any claims denied for no documentation received can be submitted for an appeal with an appeal form.

CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 3, section 90.4

National Coverage Determination (NCD) for Adult Liver Transplantation (260.1)

 

Last Updated Jan 29, 2020