The Jurisdiction A, DME MAC, Medical Review Department is conducting Targeted Probe and Educate (TPE) reviews of HCPCS codes A4253 and E2103 as well as any additional codes on the claim for the related policy. The quarterly edit effectiveness results from July 2026 - September 2026 are as follows:

Based on dollars, the overall claim potential improper payment rate is 21%.

Top Denial Reasons

• Documentation was not received in response to the Additional Documentation Request (ADR) letter.
• No medical record documentation was received. Refer to Medicare Program Integrity Manual 100-08, Chapter 5, Section 5.9.
• The medical record documentation does not support the need for the specific quantity of supplies that exceeds the usual utilization amounts described. Refer to Local Coverage Determination L33822 & Policy Article A52464.

Educational Resources

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Glucose Monitors webpage to access coverage documents (Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD)); documentation letters, forms, and checklists; reviews; tips; tools; resources; related articles; and educational events and tutorials, if applicable.

See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.