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Issue Number - Name
0030 - Osteogenesis Stimulators - Medical Necessity
Review Type
Complex
Claim Type
DME by Supplier, DME by Physician
Region and State
RAC 5
All States
Date Approved
2017-02-01

Description

Claims for osteogenesis stimulators that do not meet the indications of coverage.

Affected Codes

  • E0747, E0748, E0760

Applicable Policy References 

  • Social Security Act, Section 1833 (e)
  • Social Security Act, Section 1834 (a)
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Sections 5.2-5.6, 5.2.2, 5.2.1, 5.2.3.1, 5.2.3, 5.7- 5.9, 5.8
  • 42 Code of Federal Regulations, Section 405.980 (b) and (c)
  • 42 Code of Federal Regulations, Section 405.986
  • CMS Pub. 100-03, National Coverage Determinations Manual, Part 1, Section 150.2 
  • CGS & Noridian LCD, L33796, Effective date 10/01/2015
  • CGS & Noridian Local Coverage Article, A52513, Effective date 10/01/2015
  • NHIC LCD, L11501, Effective date 10/1/1993, Retired 09/30/2015
  • NHIC Local Coverage Article, A35349, Effective date 10/01/2005, Retired 09/30/2015
  • CGS LCD, L5012, Effective date 10/1/1993, Retired 09/30/2015
  • CGS Local Coverage Article, A25956, Effective date 04/27/2005, Retired 09/30/2015
  • NGS LCD, L27026, Effective date 10/01/1993, Retired 09/30/2015
  • NGS Local Coverage Article, A47113, Effective date 10/01/2005, Retired 09/30/2015
  • Noridian LCD, L11490, Effective date 10/1/1993, Retired 09/30/2015
  • Noridian Local Coverage Article, A35423, Effective date 04/27/2005, Retired 09/30/2015
  • CMS Policy Article, A55426