Skip to Main Content
Issue Number - Name
0080 - Group 2 Support Surfaces - DWO
Review Type
Complex
Claim Type
DME by supplier; DME by physician
Region and State
RAC 5
All States
Date Approved
2018-02-26

Description

Documentation will be reviewed to determine if Group 2 Support Surfaces meet Medicare coverage criteria and/or is medically reasonable and necessary.

Affected Code(s)

  • HCPCS codes E0277, E0371, E0372, and E0373

Applicable Policy Reference

  • 42 Code of Federal Regulations, Sections 405.980 (b)&(c) and Section 405.986
  • 42 Code of Federal Regulations, Section 424.57 (12)
  • 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, 5.7, 5.8 and 5.9 
  • Nationwide Local Coverage Determination, L33642, Effective 10/1/2015
  • Nationwide Policy Article, A52490, Effective 10/1/2015
  • CMS Policy Article, A55426, Effective 01/01/2017