PMD claims without G code are suspect, OIG says

Friday, January 23, 2015

WASHINGTON – The Office of Inspector General (OIG) calls into question claims for power mobility devices (PMDs) without corresponding G-code claims in a new report.

CMS introduced G0372 in 2005 for physicians to establish and document the need for PMDs.

The OIG found that for PMD claims with corresponding G-code claims, Medicare paid the claims in accordance with federal requirements for face-to-face requirements of beneficiaries. It found for claims without corresponding G-code claims, however, that Medicare did not always pay the claims in accordance with federal requirements. Of 100 sample claims, the OIG found 53 claims met the requirements and 47 did not.

On the basis of physician interviews, the agency concluded that many physicians are unfamiliar with the G code and the face-to-face requirements.

The OIG recommends that CMS (1) adjust the 47 sample claims representing overpayments of $115,000 (2) require physicians to use the G code when prescribing PMDs and (3) require Part B contractors to educate physicians on the use of the G code and the face-to-face requirement.