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DME contractors perform pre- and post-payment reviews on a continual basis. Through data analysis, the medical review department determines the codes they will review and then sends Additional Documentation Request (ADR) letters to suppliers that bill those codes. The following list includes those codes currently being reviewed amongst all four DME jurisdictions.
  • Positive Airway Pressure (PAP) (HCPCS E0601)
  • Ankle-Foot/Knee-Ankle-Foot Orthosis (HCPCS L1970, L4360, L4361)
  • Spinal Orthoses (HCPCS L0648, L0650)
  • Knee Orthoses (HCPCS L1832, L1833)
  • Therapeutic Shoes for Persons with Diabetes (HCPCS A5500)
  • Urological Supplies (HCPCS A4351, A4352, A4353)
  • Manual Wheelchairs (K0001 – K0004)
  • Hospital Beds (E0260)
  • Oxygen and Oxygen Equipment (E1390, E0431, E0434, E0439)
  • Pressure Reducing Support Services (E0277)
  • Immunosuppressive Drugs (J7507, J7517, J7518)
Performant Recovery, the National Home Health and Hospice and DMEPOS Recovery Audit Contractor (RAC) has posted the following CMS approved issues to their website:
  • Multiple DME Rentals in One Month (approved 3/31/2017)
  • Chest Wall Oscillation Devices (2/8/2017)
  • Tracheotomy suction catheters, suction pumps, catheters and other supplies (2/8/2017)
  • Nebulizers (2/2/2017), (4/14/2017)
  • DME billed while inpatient (2/16/2017)
  • Osteogenesis stimulators (2/14/2017)
  • Automated Excessive Units of Spring Powered Devices Billed for >1 in a 6 Month Period (1/5/2017)
  • CPM Billed without Total Knee Replacement (2/2/2017)
  • Group 2 Support Surfaces Without Correct Diagnosis of Condition (2/15/2017)
  • Glucose Monitor When Billed With Same Date of Services as Glucose Monitor Supplies (Unbundling) (1/5/2017)
  • Hospital Beds with Mattresses Billed with Group I or Group II Support Mattresses (4/12/2017)
  • L5845 with Incompatible Codes (4/12/2017)