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Issue Number - Name
0103-Complex Urological Supplies
Review Type
Complex
Claim Type
DME by Supplier, DME by Physician
Region and State
RAC 5
All States
Date Approved
2018-07-10

Description

Documentation will be reviewed to determine if the Urological Supplies meet coverage criteria and are medically reasonable and necessary.

Affected Code(s)

  • A4217, A4310-A4316, A4320-A4322, A4326-A4328, A4331-A4336, A4338, A4340, A4344, A4346, A4349, A4351-A4358, A4360, A4402, A4450,  A4452, A4455, A4456, A4520, A4553, A4554, A5102, A5105, A5112-A5114, A5131, A5200, A9270

Applicable Policy References

  • Social Security Act, Section 1862(a)(1)(A)
  • Social Security Act, Section 1861(s)(8)
  • 42 CFR 424.57(c)(12)
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.1-8, 5.3, 5.8
  • Local Coverage Determination, L33803, Effective date 10/01/2015 
  • Local Coverage Article, A52521, Effective date 10/01/2015
  • Local Coverage Article, A55426, Effective date 01/01/2017