​According to Medicare, many DMEPOS claims are denied because the item delivered is the “same as” or “similar to” and item previously dispensed to the same patient and the item is within its reasonable useful lifetime. 

How to Avoid Same or Similar Denials. Ossur.com

​According to Medicare, many DMEPOS claims are denied because the item delivered is the “same as” or “similar to” and item previously dispensed to the same patient and the item is within its reasonable useful lifetime. 

According to Medicare, many DMEPOS claims are denied because the item delivered is the "same as" or "similar to" and item previously dispensed to the same patient and the item is within its reasonable useful lifetime. All orthotic items have a Reasonable Useful Lifetime (RUL.) In general, braces have a 5 year RUL with a few of the knee orthoses having a 3 year RUL. (You will find this information in the Knee Orthoses LCD.) When a second item of the same kind is delivered to a patient within the RUL timeframe, the claim may be denied as "Same and Similar."

Prior to providing an item to a patient, check the online portal for the appropriate region to determine if another claim with the same or similar item has been filed.
Region A and D, Noridian Medicare Portal
Region B and C, CGS Medicare

Use an Advanced Beneficiary Notice of Noncoverage (ABN) if you learn the patient has received a same or similar item.

Noridian has released a chart of same or similar items for your reference. 

How to Avoid Same or Similar Denials

What does this mean for you?