Pneumatic Compression Devices (PCD) Quarterly Results of Targeted Probe and Educate Review - JA DME
Pneumatic Compression Devices (PCD) Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0651. The quarterly edit effectiveness results from April 2025 - June 2025 are as follows:
Based on dollars, the overall claim potential improper payment rate is 20%.
Top Medical Necessity Denial Reasons
- 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 which supports there has been no significant improvement or if significant symptoms remain after the trial.
- Medical record does not include symptoms and objective findings, including measurements which establish the severity of the condition.
Top Technical Denial Reasons
- Supply or accessory is denied as the base equipment is denied. Refer to applicable Local Coverage Determination/Policy Article.
- Standard written order (SWO) is missing a description of the item. Refer to 42 CFR 410.38(d)(1), Medicare Program Integrity Manual 100-08, Chapter 5, Section 5.2.2 & Standard Documentation Requirements A55426.
- Beneficiary was in an acute care hospital or skilled nursing facility on this date of service. Refer to Medicare Claims Processing Manual 100-04, Chapter 20, Sections 210-212.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Pneumatic Compression Devices webpage to access coverage documents (Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD)); documentation letters, forms, and checklists; reviews; tips; tools; resources; related articles; and educational events and tutorials, if applicable.
See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.
