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Spinal Orthoses Targeted Probe and Educate Review Updates: October-December 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 October 2018 through December 2018 are as follows:
Based on dollars, the overall claim potential improper payment rate is 29%.
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 was not received in response to the Additional Documentation Request (ADR) letter.
- Documentation does not support coverage criteria.
For complete detail see, Spinal Orthoses Quarterly Results of Targeted Probe and Educate Review
Last Updated Mon, 04 Mar 2019 10:32:33 +0000