The Centers for Medicare & Medicaid Services (CMS) released transmittal 1196 on March 8, 2013 with an effective an implementation date of April 1, 2013 regarding outpatient therapy functional reporting non-compliance alerts. For therapy claims, with dates of service on and after January 1, 2013, processed on and after April 1, 2013 through June 30, 2013, contractors shall alert providers to

From UnitedHealthcare March 2013 Network Bulletin CMS issued National Coverage Determination (NCD) 160.27 Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) effective June 8, 2012, limiting coverage of TENS for CLBP to members who are enrolled in a CMS approved clinical trial and meet certain criteria. When coverage requirements are met original Medicare will be responsible for payment of TENS for CLBP under the clinical trial, NCD 310.1 Routine Costs in Clinical Trials. Otherwise, TENS for CLBP is not covered and UnitedHealthcare Medicare Advantage Plans will no longer be responsible for payment. This applies to all members

For dates of service January 1, 2013 through December 31, 2013, all outpatient therapy claims submitted above the $3,700 threshold will be subject to prepayment medical review. CGS will send Additional Documentation Requests (ADRs) for all claims above the $3,700 threshold. In these ADRs, CGS will request the following documentation: