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Post-Payment, Service-Specific Review Announcements

To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming Fee-for-Service medical review activities. Beginning August 17, the MACs resumed with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.

On June 2, 2021, CMS announced that the MACs may continue conducting post-payment medical reviews to include dates of service after March 1, 2020.

A list of HCPCS codes and links to the widespread post-pay, service-specific review announcements are provided in the following chart:

Description HCPCS Service-Specific Review Announcement Quarterly Status Report
Ankle-Foot Orthosis L1902, L1906, L1971, L4396, L4397 View Announcement View Report
Blood Glucose Test Strips A4253 View Announcement View Report
Immunosuppressive Drugs J7503, J7507, J7518, J7520, and J7527 View Announcement  
Knee Orthoses L1833 and L1851 View Announcement View Report
Lower Limb Prostheses L5700 and L5701 View Announcement  
Lumbar Sacral Orthosis L0457, L0637, L0650, L0648 View 07.12.21 Announcement

View 08.12.20 L0650 Announcement
View 2021 Q1 L0650 Report
Manual Wheelchairs K0001-K0004 View Announcement View Report
Orthopedic Footwear L3040, L3050, and L3060 View Announcement  
Osteogenesis Stimulator E0747, E0748, and E0760 View Announcement  
Ostomy Supplies A4431, A4434, A5081, and A5122 View Announcement  
Surgical Dressing A6196, A6212, and A6010 View Announcement View Report
Therapeutic Shoes/Inserts for Diabetics A5500 and A5512-A5514 View Announcement  
Urological Supplies A4351, A4352, A4353, A4355, A4316 View Announcement View Report

Use the myCGS web portal to easily view and respond to post-payment Medical Review letters. Subscribe to our electronic mailing list and check this page for updates.

Resources:

Date: 08.13.21

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