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Region

Region A

Issue Title

CT Scans, Head and Neck, Incorrect Billing

Number

 

Description

Potential incorrect billing of CT scans not supported by medical necessity (NGS LCD 28516 (A48015))

States

NY

Provider Type

Skilled Nursing Facility

Date of Service

Claims having a "claim paid date" which is more than 3 years prior to the ADR date will be excluded.

References

Title XVIII of the Social Security Act (SSA): Section 1862(a)(1)(A);Medicare National Coverage Determination Manual, 100-03, Chapter 1, Part 4, 220.1;NGS LCD L28516 (A48015); effective 1/1/2009 to 11/14/2011 for Connecticut and New York; effective 1/1/2009 to 06/05/2009 for Vermont and New Hampshire; effective 1/1/2009 to 05/15/2009 for Maine and Massachusetts;NGS Article A48015, related to LCD L28516; ​​

Date Posted

4/2/2012

Date Revised

 

More Information

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Attachments

Created at 6/4/2013 2:20 PM by i:0#.f|crmmembershipprovider|agough@ahca.org
Last modified at 6/5/2013 10:36 AM by Aaron Gough