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Regulatory: Peformant, CGS

Regulatory: Peformant, CGS

WASHINGTON - Reformant Recovery, the National DMEPOS RAC Contractor, has added upper limb orthoses to its approved issues list. Performant will review claims for upper limb orthoses with dates of service within five years of the date of service of a previously paid upper limb orthoses for the same beneficiary. HCPCS codes identified as same, for the same anatomical site, will be denied as the reasonable useful lifetime requirement has not been met… The Jurisdiction B and C councils met recently to discuss a recent publication, Correct Billing - Continued Coverage for Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea,” that outlines the proper use of the KX modifier. The councils say the publication is not a policy update, just a clarification of existing policy, but stakeholders are concerned that's not the case and that suppliers won't have enough time to implement changes, according to a MAMES bulletin.

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