Article Detail - JA DME
Quarterly Targeted Probe and Educate (TPE) Results for Ostomy Supplies
The Jurisdiction A, DME MAC, Medical Review Department is conducting TPE Reviews of HCPCS codes A4407 and A4419. The quarterly edit effectiveness results are from October 2023 to December 2023. Based on dollars, the overall claim potential improper payment rate for JA is 26%.
The top medical necessity denial reason for JA is medical record documentation does not support a covered diagnosis.
Additional information on the top medical necessity denial reasons, the top technical denials, and any educational resources may be found at the TPE Reviews page.
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Ostomy webpage to access coverage documents such as the Local Coverage Determination (LCD) and Policy Article, documentation letters, forms, checklists, reviews, tips, tools, resources, related articles, educational events and applicable tutorials.
