Post-Pay Reviews - JE Part B
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
|Annual Wellness/Subsequent Wellness Visit, HCPCS G0438/G0439|
|End-stage renal disease (ESRD) related monthly services, CPT® Codes 90960-90962|
|HCPCS Code J7320||
Hyaluronan or derivative
|Polysomnography, CPT® Codes 95810 & 95811|
|Psychotherapy, CPT® 90834-90837|
|Therapeutic Activities, CPT® 97530|
Last Updated Tue, 11 Jan 2022 15:48:49 +0000