Spinal 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) L0648 and L0650. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 25%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • 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
  • Detailed Written Order (DWO) is incomplete or missing elements

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


            Last Updated Mon, 31 Dec 2018 13:47:20 +0000