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Issue Number - Name
0023 - Chest Wall Oscillation Devices
Review Type
Complex
Claim Type
DME by Supplier, DME by Physician
Region and State
RAC 5
All States
Date Approved
2017-02-01

Description

Medical Necessity Review: Potential incorrect billing occurred when claims for high frequency chest wall oscillation devices were billed without an indication supporting medical necessity as described in the Nationwide Local Coverage Determination (LCD) L33785 and prior MAC LCDs L27042, L12934, L12870, L12739, all retired 9/30/2015

Affected Codes

  • E0483

Applicable Policy References 

  • Title XVIII of the Social Security Act (SSA), Section 1862(a)(1)(A)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50.13.4
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26
  • Nationwide Local Coverage Determination, L33785, Effective date 10/1/2015
  • NGS Local Coverage Determination, L27042, Effective date 10/1/2003, Retired 9/30/2015
  • CGS Local Coverage Determination, L12934, Effective date 10/1/2003, Retired 9/30/2015
  • NHIC Local Coverage Determination, L12870, Effective date 10/1/2003, Retired 9/30/2015
  • Noridian Local Coverage Determination, L12739, Effective date 10/1/2003, Retired 9/30/2015