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Issue Number - Name
0029 - Group 2 Support Surfaces
Review Type
Complex
Claim Type
DME by Supplier, DME by Physician
Region and State
RAC 5
All States
Date Approved
2017-07-10

Description

Medical Necessity: Documentation will be reviewed to determine if Group 2 Support Surfaces meet Medicare coverage criteria.

Affected Codes

  • HCPCS codes: E0193, E0277, E0371, E0372, E0373

Applicable Policy References

  • 42 C.F.R. Sections 405.980 (b)&(c) and Section 405.986
  • 42 C.F.R Section 424.57 (12)
  • CMS Pub. 100-03, Medicare National Coverage Determination Manual, Section 180.1 
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Sections 5.2.3, 5.3, 5.7, 5.8, and 5.9
  • NHIC LCD, L5068, Effective date 10/1/1993, Retired 9/30/2015
  • CGS LCD, L11564, Effective date 10/1/1993, Retired 9/30/2015
  • Noridian LCD, L11579, Effective date 10/1/1993, Retired 9/30/2015
  • NGS LCD, L27009, Effective date 10/1/1993, Retired 9/30/2015
  • Nationwide LCD, L33642, Effective date 10/1/2015
  • Nationwide Policy Article, A52490, Effective date 10/1/2015
  • Noridian Policy Article, A35422, Effective date 10/1/2005, Retired 9/30/2015
  • NHIC Policy Article, A35350, Effective date 10/1/2005, Retired 9/30/2015
  • CGS Policy Article, A35357, Effective date 10/1/2005, Retired 9/30/2015
  • NGS Policy Article, A47114, Effective date 10/1/2005, Retired 9/30/2015
  • CMS Policy Article, A55426