The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A6021 and A6212. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 52%.

Top Denial Reasons

• Medical record documentation was not authenticated (handwritten or electronic) by the author
• Documentation does not support coverage criteria

For complete detail see, Surgical Dressings Quarterly Results of Targeted Probe and Educate Review