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
Results
Current
Review
Status
Annual Wellness/Subsequent Wellness Visit, HCPCS G0438/G0439
  • Active
End-stage renal disease (ESRD) related monthly services, CPT® Codes 90960-90962
  • N/A
  • Active
GenVisc 850, HCPCS Code J7320
  • N/A
  • Active
Polysomnography, CPT® Codes 95810 & 95811
  • N/A
  • Active
Psychotherapy, CPT® 90834-90837
  • Active
Therapeutic Activities, CPT® 97530
  • Active

 

Last Updated Tue, 23 Feb 2021 14:55:41 +0000