Post-Pay Reviews

The Centers for Medicare & Medicaid Services (CMS) is required to protect the Medicare Trust Fund against inappropriate payments which pose a risk to the Trust Fund. Noridian’s focus includes performing post-payment service specific reviews identified by vulnerabilities that indicate questionable billing patterns.

Information below provides a global notice of what post-payment service topic reviews are currently in process, required documentation, resources used in reviews, and any current findings if the service topic review is completed.

Review Criteria Service Specific Review Notification Current Review Status
Comprehensive Metabolic Panel (CMP), CPT® 80053
Darbepoetin Alfa, Non-ESRD, HCPCS J0881
Ferric Carboxymaltose, HCPCS J1439
Inpatient Rehab Facility (IRF)
Intravenous Hydration, CPT® 96360/96361
Outpatient Rehab Facility (ORF) Physical Therapy, Revenue Code 042X
Pembrolizumab, HCPCS J9271
Polysomnography CPT® 95810-95811

Thyroid Stimulating Hormone (TSH) Assay, CPT® 84443


Last Updated Dec 09 , 2023