US · guidance
CMS Pub. 100-04, ch. 30, § 150.5.2.6
Presumption for Listed Overutilized Items
Any denial of a claim for a particular item furnished by a particular supplier because the
item is on the §1834(a)(15)(A) list of potentially overutilized items is actual notice to that
supplier that an advance determination must be requested for all future claims for that
item, and for any other items which are identified in the same notification of denial as
being on the list of potentially overutilized items. Presume, on that basis, that that
supplier has knowledge that an advance determination must be requested for all future
claims for any and all items which are identified in the notification of denial as being on
the list of potentially overutilized items. This is a nonrebuttable presumption.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9d67e45c256076f250248f50f6a6581d5e025dd97dc4ffb8efcf614622a585c6
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