Ankle-Foot Orthoses Targeted Probe and Educate Review Updates: October-December 2018

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 October 2018 through December 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 48%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Documentation does not support custom fit criteria.
  • Documentation does not support coverage criteria.

For complete detail see, Ankle-Foot Orthoses Quarterly Results of Targeted Probe and Educate Review

            Last Updated Mon, 04 Mar 2019 10:32:11 +0000