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:
- Additional Documentation Request (ADR) Process
- COVID-19 News and Information for DMEPOS
- How to Appeal An Overpayment
- Medical Review Education Programs
- Medical Review Resources
- Post-pay available on Additional Documentation Request (ADR) screen in DME myCGS
Date: 08.13.21

