High strength, lightweight manual wheelchairs will be the subject of a service-specific prepayment review because of their high claims payment error rate, CGS, the Jurisdiction C DME MAC, announced Feb. 18.
Additional documentation required for K0004 claims may include: detailed written orders; medical records showing the beneficiary meets general manual wheelchair coverage criteria and one of the two K0004 code specific criteria; documentation of an assessment showing the beneficiary’s home can accommodate the wheelchair; delivery documentation; and copy of advance beneficiary notice.
Relevant medical records are physician notes, non-physician clinical notes and non-physician clinical evaluations showing the beneficiary’s condition meets coverage criteria. Those records may come from a physician’s office, hospital, nursing home or home health agency, according to the bulletin.
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