June 30, 2023
"Same or Similar" Resource List
There are many variations on how you search for information related to same or similar: same or similar, same and similar, same/similar, just to name a few. Our search engine is improving all the time, and results can vary depending on the search term. We recognize this is an important topic and have compiled a list of some of the most helpful tips and resources available on our website:
- Use myCGS to check claims history:
We made major enhancements to the myCGS web portal to make it easy to search claim history by product category or HCPCS. If you are looking for information on how to check for same or similar equipment in myCGS, review Chapter 4 of the DME myCGS User Manual.
If you are a supplier who serves beneficiaries in DME MAC Jurisdiction A and/or Jurisdiction D, but do not submit claims to Jurisdiction B or Jurisdiction C, review the DME myCGS Registration & Account Management Guide for information on how to enroll in myCGS as a Same/Similar User.
- Call the Interactive Voice Response (IVR) to check claims history:
The IVR System User Guide is a handy flowchart of how to access Certificate of Medical Necessity (CMN) status for same or similar equipment inquiries, diabetic supply claims history, and diabetic shoe claims history.
- Look up which HCPCS codes are considered same or similar:
Use the Same/Similar Code Lookup. Simply enter a HCPCS code in the search field to view a list of other HCPCS codes that may be the same as or similar to the base item entered.
- Understand when you can use an Advance Beneficiary Notice of Non-coverage (ABN):
The Supplier Manual Chapter 3 – Supplier Documentation features a section on when an ABN may be issued in same or similar situations. This chapter also includes information about backup equipment.
- Understand reasonable, useful lifetime and replacement guidelines:
Section 9 of the Supplier Manual Chapter 5 – DMEPOS Fee Schedule addresses replacement of an identical or nearly identical item.
- Resolve same or similar denials for orthoses or prepare for an audit:
This article was published by all four DME MACs to provide information on when orthoses that are identical or similar to items previously paid for by Medicare may be provided when the item is lost, stolen, irreparably damaged, or there has been a change in the beneficiary's medical/physiological condition: Same or Similar Denials for Orthoses and the Appeals Process.
A documentation checklist outlines required documentation: Replacement Orthosis During Reasonable Useful Lifetime
- Resolve same or similar denials when the beneficiary switches from continuous glucose monitor (CGM) supplies back to blood glucose monitor (BGM) supplies:
Billing Reminder: Blood Glucose Monitor Supplies and Continuous Glucose Monitor Supplies – Switching
- Is a second ventilator always considered same or similar?
Review this joint DME MAC publication for information about coverage of a second ventilator: Correct Coding and Coverage of Ventilators
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