CGS to Start Medical Review for Catheters

CGS, the Jurisdiction C DME MAC, has announced it will start a service-specific Medical Review edit for catheters following what it calls a high claims payment error rate.

The affected HCPCS codes are A4351 (straight-tip intermittent urinary catheter); A4352 (coude-tip intermittent urinary catheter); and A4353 (intermittent urinary catheter with insertion supplies).

CGS says suppliers of impacted claims will be asked to provide additional documentation. That documentation can include the preliminary dispensing order; detailed written order; relevant medical records that support it is medically necessary to perform intermittent catheterization; request for refill; delivery documentation; and a copy of the Advance Beneficiary Notice, if one was involved. Additional pertinent records could also be requested, CGS noted.

CGS says it must receive the additional requested information within 45 days of the date on the request letter, or the claim will be denied.

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