Immunosuppressive Drugs Targeted Probe and Educate Review Updates: April - June 2019

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) J7507, J7517, J7518, and J7520. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 7%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Documenation does not include a Detailed Written Order (DWO)

For complete detail see, Immunosuppressive Drugs Quarterly Results of Targeted Probe and Educate Review

            Last Updated Mon, 28 Oct 2019 16:02:16 +0000