Medical Review has numerous procedure codes on special review. The procedure codes are reviewed based on Local Coverage Determination (LCD) and in some instances CMS Internet Online Manual (IOM) criteria. Review of any procedure code is to determine that it meets coverage criteria.

There may be specific procedures that are reviewed by the Medical Review area which are not addressed in the list above. If you should receive a request for medical records and can not identify the specific reason for the review based on this list, please submit medical records to support the services billed as identified by date and procedure code on the request.

As your Medicare Carrier, our goal is to pay the claim correctly the first time. It is our hope that this effort will be user friendly and helpful to you. In addition, you are encouraged to regularly monitor your state Medicare web site at http://www.lamedicare.com for the Latest Updates, new policies, revised policies, retired policies, and draft policies. The draft policies offer you the opportunity to comment on-line regarding proposed policies before they are finalized.

All of this information and more is available by going to your state website at http://www.lamedicare.com, clicking on "Provider Information", and then selecting the topic of interest to you.

Our Medicare workshops are also posted on this site, as well as our Web based training for you and your staff. These are valuable educational tools that you and your office staff cannot afford to miss.

We would appreciate any comments/feedback you might offer to improve this site and encourage your comments.