Pneumatic Compression Devices (PCD) Quarterly Results of Targeted Probe and Educate Review - JA DME
Pneumatic Compression Devices (PCD) Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0651. The quarterly edit effectiveness results from July 2024 - September 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 6%.
Top Medical Necessity Denial Reasons
- Medical record does not include the clinical response to an initial treatment with the device.
- The medical record does not support the beneficiary has persistence of chronic and severe lymphedema as identified by the documented presence of at least one of the following clinical findings: marked hyperkeratosis with hyperplasia and hyperpigmentation, Papillomatosis cutis lymphostatica, deformity of elephantiasis, skin breakdown with persisting lymphorrhea, or detailed measurements over time confirming the persistence of the lymphedema with a history evidencing a likely etiology.
Top Technical Denial Reasons
- Supply or accessory is denied as the base equipment is denied. Refer to applicable Local Coverage Determination/Policy Article.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Pneumatic Compression Devices 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.
