Jurisdiction B reviews for power wheelchairs and catheters

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Friday, December 5, 2014

INDIANAPOLIS –A claim review of power wheelchair-related options and accessories (K0820-K0829) from July 1, 2014, to Sept. 30, 2014, showed a denial rate of 81%. In the previous quarter, the rate was 84%. The most common reasons for denial:The face-to-face examination did not support why a manual wheelchair or a power operated vehicle wouldn't meet the beneficiary's mobility needs in the home; face-to-face examination did not support the beneficiary's mobility limitation…Also under claim review arecatheters (A4353) for same time period, and which showed a denial rate of 93%. In the previous quarter, the rate was 91%. The most common reasons for denial: The beneficiary did not meet one out of five criteria per local coverage determinations (LCD) for coverage of intermittent catheter kits (A4353); the supplier did not document a valid refill request from the beneficiary.

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