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| Correct Billing of Dynasplint Trismus System Several claims are being reviewed on the appeal (redetermination) level regarding the Dynasplint Trismus System billed under the Not Otherwise Classified (NOC) HCPCS code E1399. National Government Services would like to provide information regarding these claims to help with the adjudication of the claims. When billing to Medicare using a NOC code, suppliers are to indicate in the Note Segment (NTE) field what the item being billed is, as well as, any useful information to help correctly adjudicate the claim. When providing the Dynasplint Trismus System, suppliers should provide the following in response to a development letter or if requesting a redetermination of the claim: Detailed written order signed and dated by the treating physician prior to claim submissionDocumentation from the physician s medical records indicating the diagnosis/condition necessitating the use of the device. The information should quantitate the degree of impairment – generally by documenting the Maximal Interincisal Distance (MID). A supplier-developed form is not sufficient documentation even if completed by the physician.For ongoing rental, documentation should include information about response to treatment – e.g., the MID on a monthly basis. Suppliers can find more information regarding filing an appeal (redetermination) on the National Government Services Web site at www.ngsmedicare.com. |
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