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Issue Number - Name
0025 - Nebulizers Billed With Diagnosis Codes Other Than Those Listed in Local Coverage Determination
Review Type
Automated
Claim Type
DME Supplier
Region and State
RAC 5
All States
Date Approved
2017-02-01

Description

Overpayments were identified where diagnosis codes were not in accordance with billing requirements outlined in Local Coverage Determinations for Nebulizers, Related Drugs, and Accessories.

Affected Codes

  • A4216, A4217, A4619, A7003, A7004, A7005, A7006, A7007, A7010, A7011, A7012, A7013, A7014, A7015, A7016, A7017, A7018, A7525, E0565, E0570, E0572, E0574, E0585, E1372, J2545, J7605, J7606, J7608, J7611, J7612, J7613, J7614, J7620, J7626, J7631, J7639, J7644, J7669, J7682, J7686, K0730, Q0474

Applicable Policy References

  • LCD Nationwide, L33370, Effective 10/1/2015 
  • 42 Code of Federal Regulations, 405.986 
  • 42 Code of Federal Regulations, 405.980 
  • CGS LCD, L5007, Retired 9/30/2015
  • NGS LCD, L27226, Retired 9/30/2015
  • NHIC LCD, L11499, Retired 9/30/2015
  • Noridian LCD, L11488, Retired 9/30/2015