Knee Orthoses 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) L1832, L1833, L1843 and L1851. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 79%.

Top Denial Reasons

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

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


            Last Updated Mon, 31 Dec 2018 13:35:32 +0000