Surgical Dressing and Knee Orthosis Codes Could See Post-Pay Reviews

The review from CGS is the result of errors and high payouts for four codes, and should impact claims filed prior to the COVID-19 PHE.

Jurisdiction B and C DME MAC contractor CGS Administrators (CGS) will be considering complex post-pay reviews for surgical dressing and knee orthosis codes.

CGS will review surgical dressing codes A6196 and A6212, as well as knee orthosis codes L1833 and L1851. 

The reviews come after CGS says it determined its allowed dollars for the codes “were significantly above expected amounts.” It added that the knee orthosis policy group ranked ninth in total CERT errors and that the surgical dressing policy group ranked fifth.

The American Association for Homecare reported that CMS has clarified that the post-pay reviews will only include claim dates prior to the COVID-19 Public Health Emergency (PHE) and that CGS will not include any during the PHE.

“CMS and the DME MACs are aware of the impact the PHE has had on the DMEPOS community and should be providing some flexibility,” a statement from AAHomecare read. “Suppliers should communicate with the DME MACs if more time is needed in responding to the Additional Documentation Request (ADR) letters.”

The full CGS announcements from CGS for each policy group:

 

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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