Enteral Nutrition 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) B4150, B4152 and B4154. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 53%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Refill request documentation is incomplete or missing elements
  • Documentation does not support coverage criteria
  • The supplier indicates the item(s) were billed in error. Refer to SDL A55426

For complete detail see, Enteral Nutrition Quarterly Results of Targeted Probe and Educate Review.


Last Updated Dec 31, 2018