The Jurisdiction A, DME MAC, Medical Review Department is conducting a post-payment service specific review of HCPCS code(s) A4253. The quarterly edit effectiveness results from May 2021 through July 2021 are as follows.

Based on dollars, the overall claim potential improper payment rate is 88% for HCPCS A4253.

Top Denial Reasons

• Documentation was not received in response to the post-payment notification letter.
• No medical record documentation was received. Refer to Medicare Program Integrity Manual 3.2.3.8.
• Documentation does not support medical necessity.
• Documentation does not support usual utilization for an insulin-treated diabetic.

Educational Resources

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Glucose Monitors webpage to access coverage documents.

• National Coverage Determination (NCD)
• Local Coverage Determination (LCD)
• Policy Article
• Documentation letters, forms, and checklists
• Review tips, tools, and resources
• Related articles
• Educational events and tutorials, if applicable

See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 for more information on medical record reviews.