Ankle-Foot Orthosis Targeted Probe and Educate Review Updates: July - September 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 July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 39%.

Top Denial Reasons

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

For complete detail see, Ankle Foot Orthosis Quarterly Results of Targeted Probe and Educate Review.

 

            Last Updated Mon, 31 Dec 2018 13:41:44 +0000