Noridian recently announced several service-specific, pre-payment reviews for suppliers billing to Jurisdiction D. Please see the list below to determine if the services you provide to beneficiaries in Jurisdiction D could be at risk for an audit.
- TENS (E0730) – Potential improper payment rate of 98 percent.
- External infusion pumps (E0781, E0784) — Potential improper payment rates of 37 percent and 61 percent (documentation compliance review).
Codes that will remain on pre-payment review due to recently published improper payment rates:
- Therapeutic shoes (A5500) – Improper payment rate of 76 percent.
- Oxygen (HCPCS E0439, E0434) – Improper payment rate of 55 and 37 percent, respectively.
- Hospital beds (HCPCS E0260) – Improper payment rate of 52 percent.
- Ankle-foot/knee-ankle-foot orthosis (HCPCS L1960, L1970, L4360, L4361) – Improper payment rate of 73, 78, 98 and 73 percent, respectively.
- Spinal orthoses (HCPCS L0648, L0650) – Improper payment rate of 99 and 98 percent, respectively.
- Knee orthoses (HCPCS L1832, L1833, L1843) – Improper payment rate of 67, 92 and 83 percent, respectively.
- Urological supplies (HCPCS A4351, A4353, A4358) – Improper payment rate of 50, 77 and 66 percent, respectively.
For complete details on these reviews, refer to the Noridian DME MAC Jurisdiction D website.