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