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Linda Collins Blogger

Same or Similar

Posted by Linda Collins | June 01, 2015


According to Medicare, braces have a Reasonable Useful Lifetime (RUL) See "What is the Useful Lifetime of a Brace?" This means that if another brace, which is the same or similar to the one originally dispensed, is provided to the beneficiary within the RUL it will be denied. How do you find out if the beneficiary has received a same or similar device in the past?

Each of the DME MACs have online ability to check if a beneficiary has received a similar brace with the expected lifetime of the device. In order to check same and similar information on L codes you will access the appropriate site for your MAC Region. The following information will be required:

  • National Provider Identifier (NPI)
  • PTAN (10-digit supplier number)
  • Last 5 digits of the Tax Identification Number (TIN)
  • Beneficiary Medicare number
  • Beneficiary first and last name (last name and first initial if using touch-tone)
  • Beneficiary date of birth
  • HCPCS code

Suppliers are reminded that when requesting same and similar information for a specific beneficiary, you must have a dispensing order on file for the particular beneficiary and item.

Here are the links to region specific sites:

NHIC Medicare, Region A

NGS Medicare, Region B

CGS Medicare, Region C

Noridian, Region D

Note: The above sites require pre-registration. Be sure to contact the Provider Outreach Specialists if you have questions about registering.

​What to do if the patient has received a same or similar device? Watch for that answer in the next post from R&R.  

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