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Therapeutic Shoes – Documentation Requirements

The National Government Services, Jurisdiction B Medical Review department recently conducted a widespread post pay probe for HCPCS codes A5500, A5501, A5512, and A5513.  A widespread post pay probe is a selection of paid claims reviewed for medical necessity based on a particular service from multiple suppliers.  The suppliers who had claims selected and reviewed for this probe have been sent final probe determination letters.  The letter indicates the probe review findings and any overpayment(s) identified. The claims that were found to have been paid in error have been adjusted and a demand letter has been generated.

The following are the most common errors found during the recent medical review audit of therapeutic shoes and inserts and clarification of documentation requirements.


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