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 July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 16%.

Top Denial Reasons

• Documentation does not support coverage criteria.
• Refill request documentation is incomplete or missing elements.

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