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CMS Approved Audit Issues

Issue Name Issue Number Review Type Provider Type Region State Date Approved Details
Wearable Automatic External Defibrillators: Medical Necessity and Documentation Requirements _0216 Complex DME Supplier and DME by Physician Region-5 Nationwide 06/08/2023 Details
Muscle Flap with Breast Reconstruction or Breast Prosthesis Insertion: Unbundling _0217 Complex Physician/Non-physician Practitioner (NPP) Region-1, Region-2, All Region 1 and Region 2 states 06/02/2023 Details
Medical Supplies Billed from Consolidated Billing List During a Home Health Episode: Unbundling _0218 Automated DME Supplier and DME by Physician Region-5 Nationwide 06/08/2023 Details
Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac Joint: Medical Necessity and Documentation Requirements _0219 Complex Outpatient Hospital ; Ambulatory Surgery Center (ASC); Professional Services Region-1, Region-2, All Region 1 and Region 2 states 06/12/2023 Details
Hip Orthoses within the Reasonable Useful Lifetime: Excessive Units _0220 Automated DME by Supplier/ DME by Physician Region-5 Nationwide 09/15/2023 Details
Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements _0221 Complex Hospice Region-5 Nationwide 12/01/2023 Details
Continuous Glucose Monitor: Medical Necessity and Documentation Requirements _0189 Complex DME by Supplier/DME Physician Region-5 Nationwide 09/08/2020 Details
Skilled Nursing Facility with Patient-Driven Payment Model: Medical Necessity and Documentation Requirements _0190 Complex SNF Region-1, Region-2, All Region 1 and Region 2 states 08/01/2022 Details
Polysomnography: Medical Necessity and Documentation Requirements _0191 Complex Outpatient Region-1, Region-2, All Region 1 and Region 2 states 09/21/2020 Details
Ventricular Assist Device: Medical Necessity and Documentation Requirements _0192 Complex Inpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 09/22/2020 Details
Implantable Automatic Defibrillators- Inpatient Procedure: Medical Necessity and Documentation Requirements _0195 Complex Inpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 10/19/2020 Details
Deep Brain Stimulation- Outpatient Procedure: Medical Necessity and Documentation Requirements _0196 Complex Outpatient; Professional Services Region-1, Region-2, All Region 1 and Region 2 states 11/17/2020 Details
Deep Brain Stimulation- Inpatient Procedure: Medical Necessity and Documentation Requirements _0198 Complex Inpatient hospital Region-1, Region-2, All Region 1 and Region 2 states 11/17/2020 Details
Air Ambulance: Medical Necessity and Documentation Requirements _0200 Complex Ambulance Region-1, Region-2, All Region 1 and Region 2 states 01/18/2021 Details
Hospice Continuous Home Care: Medical Necessity and Documentation Requirements _0201 Complex Hospice Region-5 Nationwide 02/01/2021 Details
Skilled Nursing Facility (SNF) Consolidated Billing for Ambulance Transports: Unbundling _0202 Automated Ambulance suppliers Region-1, Region-2, All Region 1 and Region 2 states 01/18/2021 Details
Vagus Nerve Stimulation: Medical Necessity and Documentation Requirements _0204 Complex Outpatient hospital, Ambulatory Surgery Center (ASC), Professional Services Region-1, Region-2, All Region 1 and Region 2 states 02/16/2021 Details
Next Generation Sequencing: Medical Necessity and Documentation Requirements _0205 Complex Laboratory Region-1, Region-2, All Region 1 and Region 2 states 05/25/2021 Details
Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity and Documentation Requirements _0206 Complex Hospital Outpatient; Professional Services Region-1, Region-2, All Region 1 and Region 2 states 05/25/2021 Details
Enteral Nutrition Therapy with Dates of Service on/after September 5 2021: Medical Necessity and Documentation Requirements _0208 Complex DME Supplier and DME by Physician Region-5 Nationwide 12/06/2021 Details
Parenteral Nutrition Therapy with Dates of Service on/after September 5, 2021: Medical Necessity and Documentation Requirements _0209 Complex DME by supplier; DME by physician Region-5 Nationwide 12/06/2021 Details
Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: Medical Necessity and Documentation Requirements _0210 Complex Outpatient Hospital, Ambulatory Surgical Center, Professional Services Region-1, Region-2, All Region 1 and Region 2 states 07/01/2022 Details
Prolonged Service Codes: Unbundling _0211 Automated Professional Services (Physician/non-physician practitioner) Region-1, Region-2, All Region 1 and Region 2 states 02/15/2023 Details
Hospice General Inpatient Care: Medical Necessity and Documentation Requirements _0212 Complex Hospice Region-5 Nationwide 04/01/2023 Details
Transurethral Waterjet Ablation of the Prostate for Benign Prostatic Hyperplasia (BPH) with Lower Urinary Tract Symptoms (LUTS): Medical Necessity and Documentation Requirements _0214 Complex Outpatient Hospital, Ambulatory Surgery Center (ASC), and Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 05/01/2023 Details
Canes, Crutches, and Walkers within the Reasonable Useful Lifetime: Excessive Units _0215 Automated DME by Supplier and DME by Physician Region-5 Nationwide 05/01/2023 Details
Outpatient Therapy Services During Home Health: Unbundling _0158 Automated Hospital Outpatient, SNF Outpatient, Outpatient Rehabilitation Facility, Comprehensive Outpatient Rehabilitation Facility Region-1, Region-2, All Region 1 and Region 2 states 07/11/2019 Details
Intravenous Immune Globulin for the Treatment of Autoimmune Blistering Diseases: Medical Necessity and Documentation Requirements _0160 Complex Hospital Outpatient; Ambulatory Surgery Center; Professional Services (physician/non-physician practitioner) Region-1, Region-2, All Region 1 and Region 2 states 08/19/2019 Details
Therapeutic, Prophylactic & Diagnostic Infusions: Incorrect Coding and Documentation Requirements _0161 Complex Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 11/19/2019 Details
Bilateral Indicator ‘3’: Incorrect Coding _0164 Automated Professional Services (Physician/non-physician practitioner) Region-1, Region-2, All Region 1 and Region 2 states 09/23/2019 Details
Positron Emission Tomography for Dementia and Neurodegenerative Diseases: Medical Necessity and Documentation Requirements _0165 Complex Outpatient Hospital, Professional Services Region-1, Region-2, All Region 1 and Region 2 states 09/24/2019 Details
Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses within the Reasonable Useful Lifetime: Excessive Units _0167 Automated DME by Supplier and DME by Physician Region-5 Nationwide 10/01/2019 Details
Outpatient Services within 3 Days Prior to and Including the Date of a Hospital Admission: Unbundling _0169 Automated Outpatient Facility Region-1, Region-2, All Region 1 and Region 2 states 11/26/2019 Details
Renal and Peripheral Angiography: Medical Necessity and Documentation Requirements _0170 Complex Outpatient Hospital (OPH); Ambulatory Surgery Center (ASC); Professional Services Region-1, Region-2, All Region 1 and Region 2 states 11/19/2019 Details
Erythropoiesis Stimulating Agents for Cancer Patients: Medical Necessity and Documentation Requirements _0171 Complex Professional Services (Physicians and Non-Physician Practitioners), Hospital Outpatient Region-1, Region-2, All Region 1 and Region 2 states 12/25/2019 Details
Surgical Dressings: Medical Necessity and Documentation Requirements _0173 Complex DME by Supplier/ DME by Physician Region-5 Nationwide 01/01/2020 Details
Cervical Orthoses within the Reasonable Useful Lifetime: Excessive Units _0174 Automated DME by Supplier and DME by Physician Region-5 Nationwide 01/01/2020 Details
Annual Wellness Visits: Incorrect Coding _0176 Complex Professional Services Region-1, Region-2, All Region 1 and Region 2 states 01/20/2020 Details
Hospital Beds: Medical Necessity and Documentation Requirements _0177 Complex DME by Supplier and DME by Physician Region-5 Nationwide 03/01/2020 Details
Manual Wheelchairs: Medical Necessity and Documentation Requirements _0178 Complex DME by Supplier and DME by Physician Region-5 Nationwide 03/01/2020 Details
Reduction of Technical Component of Diagnostic Cardiovascular Services _0182 Automated Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 08/16/2020 Details
Specialty Care Transport: Medical Necessity and Documentation Requirements _0183 Complex Ambulance Region-1, Region-2, All Region 1 and Region 2 states 08/16/2020 Details
Total Hip Arthroplasty: Medical Necessity and Documentation Requirements _0184 Complex Inpatient Hospital; Outpatient Hospital; Ambulatory Surgical Center; Professional Services Region-1, Region-2, All Region 1 and Region 2 states 08/16/2020 Details
Total Knee Arthroplasty: Medical Necessity and Documentation Requirements _0185 Complex Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Professional Services Region-1, Region-2, All Region 1 and Region 2 states 08/16/2020 Details
Duplex Scans of Extracranial Arteries: Medical Necessity and Documentation Requirements _0186 Complex Outpatient Region-1, Region-2, All Region 1 and Region 2 states 08/16/2020 Details
Nerve Conduction Studies: Excessive Units _0187 Complex Outpatient Region-1, Region-2, All Region 1 and Region 2 states 09/21/2020 Details
Cardiac Rehabilitation: Medical Necessity and Documentation Requirements _0135 Complex Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 03/07/2019 Details
Medical Necessity and Coding of Chest X-Rays _0136 Complex Outpatient hospital Region-1, Region-2, All Region 1 and Region 2 states 04/25/2019 Details
Skilled Nursing Facility Consolidated Billing for Therapies: Unbundling _0138 Automated Physician/non-physician practitioner, Physical Therapist, Occupational Therapist, Speech-language Pathologist Region-1, Region-2, All Region 1 and Region 2 states 02/19/2019 Details
Vertebroplasty or Kyphoplasty: Medical Necessity and Documentation Requirements _0139 Complex Hospital Outpatient; Ambulatory Surgery Center (ASC); Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 02/19/2019 Details
Pulmonary Rehabilitation: Medical Necessity and Documentation Requirements _0140 Complex Hospital Outpatient Region-1, Region-2, All Region 1 and Region 2 states 03/27/2019 Details
Therapeutic Shoes and Inserts for Persons with Diabetes: Medical Necessity and Documentation Requirements _0141 Complex DME by Supplier and DME by Physician Region-5 Nationwide 04/26/2019 Details
Ambulatory Surgical Center Services Billed During a Covered Part A Skilled Nursing Facility Stay: Unbundling _0142 Automated Ambulatory Surgery Center (ASC) Skilled Nursing Facility (SNF) Region-1, Region-2, All Region 1 and Region 2 states 04/01/2019 Details
Prefabricated Knee Orthoses: Medical Necessity and Documentation Requirements _0144 Complex DME by Supplier/ DME by Physician Region-5 Nationwide 03/15/2019 Details
Endovenous Radiofrequency Ablation and Endovenous Laser Treatment for Lower Extremity Varicose Veins: Medical Necessity and Documentation Requirements _0145 Complex Ambulatory Surgical Centers(ASC), Professional Services Region-1, Region-2, All A/B MACs 08/01/2024 Details
Computed Tomography Scans: Excessive Units _0146 Automated All Provider Specialties Region-1, Region-2, All Region 1 and Region 2 states 03/26/2019 Details
Magnetic Resonance Imaging Procedures: Excessive Units _0147 Automated Professional Services, Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 03/27/2019 Details
Same Knee Orthoses within Reasonable Useful Lifetime: Excessive Units _0148 Automated DME by Supplier and DME by Physician Region-5 Nationwide 05/01/2019 Details
Subsequent Hospital Visit and Discharge Day Management on the Same Day: Unbundling _0149 Automated Professional Services Region-1, Region-2, All Region 1 and Region 2 states 04/18/2019 Details
Mohs Micrographic Surgery: Incorrect Coding and Incorrect Units Billed _0150 Complex Physicians and Non-Physician Practitioners Region-1, Region-2, All Region 1 and Region 2 states 04/30/2019 Details
Physician/Non-Physician Practitioner Coding Validation _0151 Complex Physician/Non-Physician Practitioner Region-1, Region-2, All Region 1 and Region 2 states 04/23/2019 Details
Blood Glucose Test or Reagent Strips: Medical Necessity and Documentation Requirements _0152 Complex DME by Supplier/DME Physician Region-5 Nationwide 06/14/2019 Details
Ambulatory Surgical Center Coding Validation _0153 Complex Ambulatory Surgical Center (ASC) Region-1, Region-2, All Region 1 and Region 2 states 05/26/2019 Details
Non-Emergency Ambulance Services- Advanced Life Support and Basic Life Support: Medical Necessity and Documentation Requirements _0154 Complex Ambulance Region-1, Region-2, All Region 1 and Region 2 states 05/20/2019 Details
Upper Limb Orthotics within the Reasonable Useful Lifetime: Excessive Units _0155 Automated DME by Supplier and DME by Physician Region-5 Nationwide 05/17/2019 Details
Discontinued Procedure Prior to the Administration of Anesthesia: Documentation Requirements _0157 Complex Hospital Outpatient; Ambulatory Surgery Center (ASC) Region-1, Region-2, All Region 1 and Region 2 states 06/26/2019 Details
Ambulatory Payment Classification Coding Validation _0101 Complex Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 07/26/2018 Details
Urological Supplies: Medical Necessity and Documentation Requirements _0103 Complex DME by supplier; DME by physician Region-5 Nationwide 07/19/2018 Details
Add-on Code Paid without Primary Code and/or Denied Primary Code – Ambulatory Surgical Center _0104 Automated Ambulatory Surgery Center (ASC) Region-1, Region-2 All Region 1 and Region 2 states 07/26/2018 Details
Parenteral Nutrition: Medical Necessity and Documentation Requirements _0106 Complex DME by supplier; DME by physician Region-5 Nationwide 09/14/2018 Details
Custom-Fabricated Knee Orthoses: Medical Necessity and Documentation Requirements _0107 Complex DME by supplier; DME by physician Region-5 Nationwide 09/14/2018 Details
Facility vs Non Facility Reimbursement: Incorrect Coding _0108 Automated Physician/Non-Physician Practitioner Region-1, Region-2, All Region 1 and Region 2 states 09/14/2018 Details
Skilled Nursing Facility Consolidated Billing: Part B – Use of Modifier 26, Professional Component _0110 Automated Physician/Non-Physician Practitioner (professional services) Region-1, Region-2, All Region 1 and Region 2 states 09/20/2018 Details
Transthoracic Echocardiography: Medical Necessity and Documentation Requirements _0111 Complex Hospital Inpatient (Medicare Part B only); Outpatient; Skilled Nursing- Inpatient (Medicare Part B only) Region-1, Region-2, All Region 1 and Region 2 states 10/12/2018 Details
Durable Medical Equipment Billed during Hospice Period: Unbundling _0114 Automated DME Supplier/DME by Physician Region-5 Nationwide 09/20/2018 Details
Physician Claims with Place of Service Home Overlapping Inpatient Hospital Stay: Services Billed Not Rendered _0115 Automated Physician Claims Region-1, Region-2, All Region 1 and Region 2 states 10/16/2018 Details
Modifiers TC and 26: Incorrect Coding _0116 Automated Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 10/12/2018 Details
Epidural Steroid Injection: Medical Necessity and Documentation Requirements _0119 Complex Professional services, Outpatient Hospital Region-1, Region-2 MAC jurisdictions JF/JE, JH/JL 09/19/2018 Details
Technical Component of Diagnostic Procedures During Inpatient: Unbundling _0123 Automated Physician/Non-Physician Practitioner Independent Diagnostic Testing Facility (IDTF) Region-1, Region-2, All Region 1 and Region 2 states 12/10/2018 Details
Part B Therapies during Inpatient: Unbundling _0124 Automated Physical Therapist, Occupational Therapist, Speech Language Therapist Region-1, Region-2, All A/B MACs 11/29/2018 Details
Endoscopy Procedures: Diagnostic and Surgical Billed Same Day _0126 Automated Independent Diagnostic Testing Facility (IDTF) Region-1, Region-2, All Region 1 and Region 2 states 11/27/2018 Details
Spinal Orthosis (TLSO/ LSO) within the Reasonable Useful Lifetime: Excessive Units _0128 Automated DME by Supplier and DME by Physician Region-5 Nationwide 01/01/2019 Details
Hyperbaric Oxygen Therapy for Diabetic Wounds: Medical Necessity and Documentation Requirements _0129 Complex Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 01/29/2018 Details
Panniculectomy: Medical Necessity and Documentation Requirements _0130 Complex Ambulatory Surgical Center (ASC); Professional Services Region-1, Region-2 All A/B MACs 08/01/2024 Details
Pneumatic Compression Devices: Medical Necessity and Documentation Requirements _0131 Complex DME Supplier and DME by Physician Region-5 Nationwide 01/23/2019 Details
Cryosurgery of the Prostate: Medical Necessity and Documentation Requirements _0134 Complex Outpatient Hospital, Ambulatory Surgery Center (ASC) and Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 02/14/2019 Details
Inpatient Rehabilitation Facility: Medical Necessity and Documentation Requirements _0073 Complex Inpatient Rehabilitation Facility Region-1, Region-2, All Region 1 and Region 2 states 10/12/2018 Details
Drugs and Biologicals in Single-Dose Vials: Incorrect Units Billed _0074 Complex Outpatient Hospital; Professional Services Region-1, Region-2, All Region 1 and Region 2 states 01/11/2018 Details
Home Health: Medical Necessity and Documentation Requirements _0075 Complex Home Health Agencies Region-5 All HHA MACs except for the following demonstration states: Delaware, District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia 06/13/2017 Details
Annual Wellness Visit Billed Sooner Than Eleven Whole Months Following the Initial Preventive Physical Examination _0077 Automated Professional Services Region-1, Region-2, All Region 1 and Region 2 states 01/15/2018 Details
Group 2 Support Surfaces: Medical Necessity and Documentation Requirements _0080 Complex DME by supplier; DME by physician Region-5 Nationwide 02/20/2018 Details
Negative Pressure Wound Therapy: Medical Necessity and Documentation Requirements _0081 Complex DME by supplier; DME by physician Region-5 Nationwide 02/26/2018 Details
Laboratory Services Rendered During an Inpatient Stay: Unbundling _0085 Automated Laboratory/Ambulance; Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 03/19/2018 Details
Observation Evaluation & Management (E&M) Services Billed Same Day as Inpatient Admission: Unbundling _0086 Automated Physician/Non-Physician Practitioner Region-1, Region-2, All Region 1 and Region 2 states 03/19/2018 Details
Laboratory Services for End-Stage Renal Disease Subject to Part B Consolidated Billing: Unbundling _0087 Automated Professional Services(Physician/Non-Physician Practitioner); Laboratory Region-1, Region-2, All Region 1 and Region 2 states 03/16/2018 Details
Ancillary Services Billed Without an Approved Surgical Procedure _0088 Automated Ambulatory Surgery Center (ASC) Region-1, Region-2, All Region 1 and Region 2 states 03/16/2018 Details
Clinical Social Worker during Inpatient: Unbundling _0089 Automated Clinical Social Workers Region-1, Region-2, All Region 1 and Region 2 states 03/19/2018 Details
Laboratory/Pathology Technical Component for Inpatient or Outpatient Hospitals: Unbundling _0090 Automated Physician/Non-Physician Practitioner Lab Independent Diagnostic Testing Facility (IDTF) Region-1, Region-2, All Region 1 and Region 2 states 04/04/2018 Details
Duplicate Claims- Professional Services _0091 Automated Part B Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2 All Region 1 and Region 2 states 05/11/2018 Details
Percutaneous Implantation of Neurostimulator Electrode Array: Medical Necessity and Documentation Requirements _0092 Complex Outpatient Hospital, (OPH); Ambulatory Surgery Center (ASC); Physician/Non-physician Practitioner (NPP) Region-1, Region-2, All Region 1 and Region 2 states 05/08/2018 Details
Implantable Automatic Defibrillators- Outpatient Procedure: Medical Necessity and Documentation Requirements _0093 Complex Outpatient Hospital, ASC Region-1, Region-2, All Region 1 and Region 2 states 05/15/2018 Details
Group 3 Pressure-Reducing Support Surfaces: Medical Necessity and Documentation Requirements _0094 Complex DME by supplier; DME by physician Region-5 Nationwide 05/15/2018 Details
Facet Joint Interventions: Medical Necessity and Documentation Requirements _0095 Complex Hospital Inpatient (Part B) 12x Outpatient 13x Outpatient Surgery 83x Region-1, Region-2, All Region 1 and Region 2 states 09/15/2023 Details
Critical Care Professional Services: Unbundling _0098 Automated Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 06/13/2018 Details
Skilled Nursing Facility Consolidated Billing: Unbundling _0099 Automated Outpatient Facility Region-1, Region-2, All Region 1 and Region 2 states 06/20/2018 Details
Add-On Code Paid without Primary Code and/or Denied Primary Code: Clinical Laboratory _0100 Automated Laboratory Region-1, Region-2, All Region 1 and Region 2 states 06/21/2018 Details
Osteogenesis Stimulators: Medical Necessity and Documentation Requirements _0030 Complex DME by Supplier and DME by Physician Region-5 Nationwide 01/01/2017 Details
Hospital Services: Excessive Units _0037 Automated Professional Services Region-1, Region-2, All Region 1 and Region 2 states 02/23/2017 Details
Visits to Patients in Swing Beds: Incorrect Coding _0038 Automated Professional Services (Physician/ Non- Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 02/23/2017 Details
Ophthalmology Codes for New Patient: Incorrect Coding _0039 Automated Physician; Professional Services Region-1, Region-2, All Region 1 and Region 2 states 03/09/2017 Details
Evaluation and Management Services for Office or Other Outpatient Visit Billed for Hospital Inpatients: Incorrect Coding _0042 Automated Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 03/09/2017 Details
New Patient Visits: Incorrect Coding _0043 Automated Physician/Non- Physician Practitioner Region-1, Region-2, All Region 1 and Region 2 states 03/09/2017 Details
Panretinal (Scatter) Laser Photocoagulation: Excessive Frequency _0047 Automated Outpatient Hospital (OPH), Physician/Non-physician Practitioner Region-1, Region-2, J6, JK, J15 04/28/2017 Details
Ambulance Transfer between Skilled Nursing Facilities: Unbundling. _0049 Automated Ambulance Providers Region-1, Region-2, All Region 1 and Region 2 states 08/09/2017 Details
Add-on Codes Paid without Primary Code and/or Denied Primary Code _0050 Automated Professional Services/Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 04/11/2017 Details
Global versus Technical Component/Professional Component Reimbursements: Unbundling _0051 Automated Physician/Non-physician Practitioner (NPP), Lab/Ambulatory Services. Region-1, Region-2, All Region 1 and Region 2 states 05/04/2017 Details
Ambulance Billed during Inpatient: Unbundling _0054 Automated Ambulance Providers Region-1, Region-2, All Region 1 and Region 2 states 05/31/2017 Details
Evaluation and Management Services in Skilled Nursing Facilities: Incorrect Coding _0056 Automated Physician/Non-physician Practitioner (NPP) Region-1, Region-2, All Region 1 and Region 2 states 08/02/2017 Details
Untimed Therapy: Excessive Units _0060 Automated Outpatient Hospital, Skilled Nursing Facility (SNF), Outpatient Rehabilitation Facility (ORF), Comprehensive Outpatient Rehabilitation Facility (CORF), Physician and Non-physician Practitioner/Provider Specialty, Therapists in Private Practice Region-1, Region-2, All Region 1 and Region 2 states 09/20/2017 Details
Nursing Facility Services: Excessive Units _0061 Automated Professional (Physician/Non-Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 09/08/2017 Details
Radiology: Technical Component during Inpatient Stay _0062 Automated Radiologists and other Part B providers performing radiology services Region-1, Region-2, All Region 1 and Region 2 states 09/07/2017 Details
Facility Duplicate Claims _0064 Automated Inpatient Hospital, Outpatient Hospital, Skilled Nursing Facility (SNF) Region-1, Region-2, All Region 1 and Region 2 states 09/07/2017 Details
Continuous Positive Airway Pressure Machine without an Obstructive Sleep Apnea Diagnosis _0065 Automated DME Supplier, DME by Physician Region-5 Nationwide 09/08/2017 Details
Inpatient Psychiatric Facility Services: Medical Necessity and Documentation Requirements _0067 Complex Inpatient Hospital (8), Inpatient Psychiatric Facility (IPF) (15) Region-1, Region-2, All Region 1 and Region 2 states 11/15/2019 Details
Respiratory Assist Devices: Medical Necessity and Documentation Requirements _0069 Complex DME by supplier; DME by physician Region-5 Nationwide 12/17/2017 Details
Outpatient Service Overlapping or During an Inpatient Stay: Duplicate Payments _0072 Automated Hospital Outpatient, Hospital Inpatient Part B Region-1, Region-2, All Region 1 and Region 2 states 10/26/2017 Details
Cataract Removal: Medical Necessity and Coding Requirements _0002 Complex Ambulatory Surgery Center (ASC); Outpatient Hospital Region-1, Region-2, CGS, Cahaba, First Coast, NGS, Noridian, Novitas, Palmetto **please note-WPS is excluded** 02/07/2017 Details
Sacral Neurostimulation: Medical Necessity and Documentation Requirements _0003 Complex Inpatient hospital-acute care; outpatient hospital; professional services (physician/non-physician practitioner); ASC Region-1, Region-2, All Region 1 and Region 2 states 02/17/2017 Details
Skilled Nursing Facility: Medical Necessity and Documentation Requirements _0004 Complex SNF Region-1, Region-2, All Region 1 and Region 2 states 06/01/2017 Details
Bariatric Surgery: Medical Necessity and Documentation Requirements _0008 Complex Inpatient Hospital, Outpatient Hospital Region-1, Region-2, All Region 1 and Region 2 states 02/01/2017 Details
Inappropriate Billing of Home Visit Professional Service Evaluation and Management Codes During Hospital Inpatient Stay _0011 Automated Professional Services (Physician/ non Physician Practitioner) Region-1, Region-2, All Region 1 and Region 2 states 02/01/2017 Details
Blood Glucose Monitors with Integrated Voice Synthesizer: Medical Necessity and Documentation Requirements _0012 Complex DME Supplier and DME by Physician Region-5 Nationwide 05/08/2017 Details
Glucose Monitor Supplies Billed With Same Dates of Service as Glucose Monitor: Unbundling _0014 Automated DME by Supplier, DME by Physician Region-5 Nationwide 01/05/2017 Details
Enteral Nutrition Therapy: Medical Necessity and Documentation Requirements _0015 Complex DME Supplier and DME by Physician Region-5 Nationwide 05/11/2017 Details
Continuous Passive Motion Billed without Total Knee Replacement or Total Knee Revision _0016 Automated DME by Supplier/ DME by Physician Region-5 Nationwide 02/02/2017 Details
Spring-Powered Devices: Excessive Units _0018 Automated DME by Supplier, DME by Physician Region-5 Nationwide 01/05/2017 Details
Durable Medical Equipment Billed while Inpatient: Unbundling _0019 Automated DME by Supplier, DME by Physician Region-5 Nationwide 02/16/2017 Details
Patient Lifts: Medical Necessity and Documentation Requirements _0020 Complex DME by Supplier, DME by Physician Region-5 Nationwide 06/01/2017 Details
Tracheotomy Suction Pumps and Suction Catheters: Medical Necessity and Documentation Requirements _0021 Complex DME by Supplier and DME by Physician Region-5 Nationwide 02/08/2017 Details
Inpatient Psychiatric Admission Billed without Source of Admission Equal to “D” _0022 Automated Inpatient Hospital (8), Inpatient Psychiatric Facility (IPF) (15) Region-1, Region-2, All Region 1 and Region 2 states 02/09/2017 Details
High Frequency Chest Wall Oscillation Devices: Medical Necessity and Documentation Requirements _0023 Complex DME by Supplier and DME by Physician Region-5 Nationwide 02/08/2017 Details
Spinal Orthoses: Medical Necessity and Documentation Requirements _0024 Complex DME by supplier; DME by physician Region-5 Nationwide 08/02/2017 Details
Nebulized Drugs: Medical Necessity and Documentation Requirements _0026 Complex DME by Supplier and DME by Provider Region-5 Nationwide 04/14/2017 Details
Annual Wellness Visits: Excessive Units _0028 Automated Physician/Non- Physician Practitioner Region-1, Region-2, All Region 1 and Region 2 states 03/30/2017 Details
Inpatient Hospital MS-DRG Coding Validation _0001 Complex Inpatient Hospital (IPH) Region-1, Region-2 All Region 1 and Region 2 states 02/01/2017 Details
Non-Physician Billed Without Correct Assistant at Surgery Modifier: Incorrect Coding _0222 Automated Part B Professional Services (Physician/Non-Physician Practitioner) Region-1, Region-2 All Region 1 and Region 2 states 07/15/2024 Details
Ankle-Foot Orthoses / Knee-Ankle-Foot Orthoses: Medical Necessity and Documentation Requirements _0013 Complex DME by Supplier/DME by Physician Region-5 Nationwide 07/05/2017 Details

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Data mining is not just automation and claims edits. Performant Healthcare SolutionsSM ...
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MSP Advantage

Our eligibility experts leverage an extensive database and proprietary algorithms to identify and validate other coverage...
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TPL Advantage

While regulations support other forms of coverage as primary before Medicaid, there is no single source...
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Recovery Advantage

Performant Healthcare SolutionsSM foundation is built on delivering solutions that quickly and efficiently...
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CMS RAC

A distinction of Performant’s services is our commitment to provider outreach on behalf of our health plan clients.

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Performant provides technology-enabled audit, recovery, and analytics services in the United States with a focus in the healthcare payment integrity industry.

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Solutions

MSP Advantage®
TPL Advantage®
Recovery Advantage®
Back to Main Menu

CMS RAC

A distinction of Performant’s services is our commitment to provider outreach on behalf of our health plan clients.

Overview

Resources

News & Alerts
Secure Provider Portal
Update Provider Contact Information
Back to Main Menu

About Us

Back to Main Menu

For Investors

Performant provides technology-enabled audit, recovery, and analytics services in the United States with a focus in the healthcare payment integrity industry.

Overview

Stock Information

Financials

Governance

Resources

News
Events & Presentations