National Government Services (NGS), the Jurisdiction B DME MAC, has announced a prepayment medical review of all claims for intermittent catheters with insertion supplies.
The HCPCS code involved is A4353, and NGS says the review “will be focused on suppliers billing claims for code A4353 that have not been subject to complex review.”
Suppliers involved in the prepayment review will be sent an additional documentation request (ADR) letter. The documentation must be sent to NGS within 30 days of the date on the letter, or NGS will deny the claim as not medically necessary.
NGS says the additional documentation should include a “detailed written order signed and dated by the treating physician including all the following elements: the items to be dispensed; the specific frequency of testing; the treating physician’s signature; the date of the treating physician’s signature; a start date of the order – only required if the start date is different than the signature date.”
The additional documentation should also include documentation from the physician’s records that supports “the medical necessity for the frequency of the catheterization that is ordered,” as well as the usual maximum quantity of supplies; KX and GY modifiers, as appropriate; proof of request for refill; and itemized proof of delivery.