National Government Services, the Jurisdiction B Medical Review, will be conducting a widespread prepayment medical review of random claims for CPAP devices/HCPCS E0601KJ.
Suppliers of the selected claims will be sent a documentation request letter in the mail, according to a notification from National Government Services. “The requested documentation must be returned within 30 days from the date of the letter or the claim will be denied as not medically necessary.”
The carrier encouraged suppliers to familiarize themselves with coverage criteria and documentation requirements as outlined in the Local Coverage Determination L27230 titled Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, the Policy Article, and the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Supplier Manual.
