Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) Targeted Probe and Educate Review Updates: April-June 2019

The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) L1970, L4360, and L4361. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 34%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Documentation does not include verification that the equipment was lost, stolen or irreparably damaged in a specific incident
  • Claim is the same or similar to another claim on file
  • Detailed Written Order (DWO) is incomplete or missing elements

For complete detail see, Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) Quarterly Results of Targeted Probe and Educate Review

            Last Updated Tue, 22 Oct 2019 12:48:23 +0000