The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) L1832, L1833, L1843, and L1851. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 62%.

Top Denial Reasons

• Documentation was not received in response to the Additional Documentation Request (ADR) letter
• Documentation does not support coverage criteria
• Advance Beneficiary Notice of Noncoverage (ABN) was not properly executed
• Documentation does not support custom fit criteria

For complete detail see, Knee Orthoses Quarterly Results of Targeted Probe and Educate Review