Oxygen Targeted Probe and Educate Review Updates: April - June 2018

The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0431 and E1390. The quarterly edit effectiveness results from April 2018 - June 2018 are as follows:

  • Based on dollars, the overall claim potential improper payment rate is 41%.

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 a qualifying blood gas study obtained during exercise.

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

Last Updated Sep 11, 2018