Immunosuppressive Drugs Targeted Probe and Educate Review Updates: October - December 2018

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 October – December 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.
  • Refill request was not received.
  • Detailed Written Order (DWO) was not received.
  • No medical record documentation was received. Refer to Medicare Program Integrity Manual 3.2.3.8.

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

            Last Updated Tue, 05 Mar 2019 10:25:32 +0000