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
Cataract Removal, CPT® 66984 Surgical Required Documentation Surgical References	View Targeted Notification	Closed AK, ID, OR, WA T2105-100 - View Final Findings AZ, UT, MT, ND, SD, WY T2105-101 - View Final Findings
Hyperbaric Oxygen (HBO) Therapy, HCPCS G0277 HBO Therapy Services Required Documentation HBO Therapy References	View Targeted Notification	Closed T2101-101 - View Final Findings
Inpatient Rehab Facility (IRF) IRF Required Documentation IRF References	View Targeted Notification	Closed T2010-101 - View Final Findings
Intravenous Hydration, CPT® 96360/96361 Drugs, Biologicals and Injections Required Documentation Drugs, Biologicals and Injections References	View Targeted Notification	Closed MT T2009-100 - View Final Findings WY T2010-102 - View Final Findings AZ T2010-104 - View Final Findings WA T2010-103 - View Final
Outpatient Rehab Facility (ORF) Physical Therapy, Revenue Code 042X Outpatient Therapy Required Documentation Outpatient Therapy References	View Targeted Notification	Closed T2010-100 - View Final Findings
Polysomnography CPT® 95810-95811 Polysomnography Required Documentation Polysomnography References	View Targeted Notification	Closed T2101-100 - View Final Findings
Total Knee Arthroplasty, CPT® 27447 Total Knee Arthroplasty Required Documentation Total Knee Arthroplasty References	View Targeted Notification	Closed AK, ID, OR, WA T2105-102 - View Final Findings AZ, UT, MT, ND, SD, WY T2105-103 - View Final Findings

Last Updated Dec 09 , 2023

Jurisdiction F - Medicare Part A

Post-Pay Reviews - JF Part A

Medical Review

Post-Pay Reviews