Top Medical Necessity Denial Reasons for Pneumatic Compression Devices

Through the Targeted Probe and Educate (TPE) program, Noridian has identified the top medical necessity denial reasons for pneumatic compression devices (PCD):

  • The medical record does not include the clinical response to an initial treatment with the device.
  • Medical record documentation does not include a four-week trial of conservative therapy demonstrating a failed response to treatment.
  • The medical record does not include symptoms or objective findings, including measurements that establish the severity of the condition.

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Pneumatic Compression Devices (PCD) webpage to access coverage documents such as Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD), documentation letters, forms, checklists, reviews, tips, tools, resources, related articles, and educational events and tutorials, if applicable.

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