Wiki DME Denial for competitive bidding

klamond

Networker
Messages
60
Location
Edison, NJ
Best answers
0
We received denial for a knee brace (L1833) from Noridian DME- M115- this item denied when provided to this patient by a non-demonstration provider. It advised there are no appeal rights. We are authorized to dispense DME's in our office. I did read up on competitive bidding contracts and attended a webinar in October. Our office never submitted a "bid" but I had asked this question to the moderator and she advised we can still dispense but we would just be paid at the "competitive bid" rate. Anyone have any suggestions on how to proceed with this since there are no appeal rights? I did call Noridian but they advised me to check their website...still stumped....
 
I had the same denial - I had never even heard of competitive bidding and I called Noridian and was told that because we are a physicians office and only give spinal/knee braces to our own patients, we didn't need to have a competitive bid, but we needed to append a modifier. I swear she said KZ and I tried it but got another denial, so I looked up that code (should've done that first, oops) and it's not right, BUT I do see that there are KG (standard product category), KK (complex product category), (KU & KW reserved for future use), and KY (wheelchair). I am trying to figure out which one applies to our situation and I think it might be KG. I am going to try billing L1833-KG-KX-LT and L0650-KG and see if they go through. If you have had any luck, please let me know!
 
I actually contacted a DME company that I did a webinar with prior to the competitive bidding dates and they helped me out. Try using "KV". This modifier indicates this item is being furnished to a patient as part of the physician’s services. The date of service must be the same as the date the brace is dispensed. Use the KX and laterality also. My claims were reprocessed and paid. For Lumbar orthosis, I used CG and KV. Hope this helps!
 
Can anyone advise on billing a replacement brace? I am billing L0650-RA and am receiving a denial for same or similar to equipment already being used. Also the same for a replacement knee brace L1833-KX-RA-RT. My understanding is the RA modifier specifies that this is a replacement. Someone please help!
 
Can anyone advise on billing a replacement brace? I am billing L0650-RA and am receiving a denial for same or similar to equipment already being used. Also the same for a replacement knee brace L1833-KX-RA-RT. My understanding is the RA modifier specifies that this is a replacement. Someone please help!
Try adding the KV,KX, RA modifier for the knee and KV, CG, RA for the back
 
Can anyone advise: Billing L1833 KX KV RT for member who resides out of area. The member resides in an area which shows on the competitive bidding list. The claim denied "service /procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated." DME rep said the face to face office visit has to be billed on same day as DME code.
The problem is the visit was 4.26.23 and the DME is billed the day of dispense -5.1.23 because we had to obtain prior authorization. DME rep said we need to bill the L1833 with the same DOS as the OV which has the face to face encounter and order noted, not necessarily the date of dispense. Does that sound right???? of course, this is not document in the cms guidelines. I asked if we were supposed to have another OV for date of dispense, she said no.
 
Top