Spinal Orthoses Targeted Probe and Educate Review Updates: April-June 2019

The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) L0648 and L0650. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 63%.

Top Denial Reasons

  • Claim is the same or similar to another claim on file
  • Documentation does not include verification that the equipment was lost, stolen or irreparably damaged in a specific incident
  • Documentation does not support coverage criteria
  • Medical record documentation was not authenticated (handwritten or electronic) by the author

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

            Last Updated Tue, 22 Oct 2019 12:56:00 +0000