Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service.
The Targeted Probe and Educate program (intensive education to assess provider compliance through up to 3 rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.
Currently, the DME MACs have announced widespread postpayment reviews on the following product categories:
Product Category |
HCPCS |
|---|---|
Ankle-Foot Orthoses |
L1902, 1906, L1940, L1970, L1971, L4360, L4361, L4396, L4397 |
Blood Glucose Test Strips |
A4253 |
Immunosuppressive Drugs |
J7503, J7507, J7518, J7520, J7527 |
Knee Orthoses |
L1833, L1851 |
Lower Limb Prostheses |
L5700, L5701 |
Manual Wheelchairs |
K0001-K0004 |
Orthopedic Footwear |
L3040, L3050, L3060 |
Osteogenesis Stimulators |
E0747, E0748, E0760 |
Ostomy Supplies |
A4414, A4407-A4409, A4431, A4434, A5081, A5122 |
Surgical Dressings |
A6010, A6196, A6197, A6212 |
Therapeutic Shoes for Diabetics |
A5500, A5512-A5514 |
TLSO/Lumbar Sacral Orthoses |
L0457, L0631, L0650 |
Urological Supplies |
A4351 – A4353, A4355, A4316 |
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