Watch Arthritis Kits, TriCenturion Warns

TriCenturion, the Jurisdiction B DME Program Safeguard
Contractor, said it has has identified a number of suppliers who
are marketing what are often described as “arthritis kits.”
According to a June 5 notice, the PSC said advertisements for these
kits — which can include multiple upper limb, lower limb and
spinal “orthotics” and/or heat lamps — “entice beneficiaries
and obtain physician orders by stating that the items are ‘Medicare
approved’ and that there will be no cost to the beneficiary (if
he/she has a Medicare aupplement plan).”

But the PSC pointed to several problems with the kits in cases
it has investigated: Many of the items are billed using incorrect
HCPCS codes; many are statutorily noncovered by Medicare; and “in
almost all cases,” documentation does not support the medical
necessity for the items.

“A simple diagnosis of arthritis or other general statement is
not sufficient,” the PSC said. “The history and physical
examination must document the severity of the condition and the
need for each item. Since it would rarely be medically necessary to
order multiple orthoses at the same time, the greater the number of
items provided, the more detailed is the documentation that would
be required.”