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David McGill Blogger

A Follows B

Posted by David McGill | April 03, 2013

In our Feburary 21 post, we noted that MAC Region B had updated its requirements for claims using "not otherwise classified" codes (e.g., L5999 in prosthetics). MAC Region A has now followed suit.

On April 1, Region A announced revised guidelines for NOC codes. Suppliers must now include:


  • Product name;
  • Make/model of the item; and
  • MSRP.

What does this mean for you?

As we've discussed several times in the recent past, we believe this these requirements demonstrate the MACs' intent to increasingly focus on the specific products delivered by suppliers to beneficiaries. If you intend to use an NOC code like L5999, you need to make sure that it's appropriate, as the MACs may be scrutinizing NOCs more closely to identify potential coding abuse.     


The new requirements take effect May 1st. ​Failure to follow them will result in claim denials.

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