Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) Targeted Probe and Educate Review Updates: July - September 2018

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) L4360, L4361, L4386 and L4387. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 34%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Documentation does not support coverage criteria

For complete detail see, Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) Quarterly Results of Targeted Probe and Educate Review.

 

Last Updated Dec 31, 2018