Manual Wheelchair 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) K0001 and K0003. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 58%.

Top Denial Reasons

  • Documentation does not support coverage criteria
  • Detailed Written Order (DWO) is incomplete or missing elements
  • Documentation does not support coverage criteria for a lightweight wheelchair
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter

For complete detail see, Manual Wheelchair Quarterly Results of Targeted Probe and Educate Review.


            Last Updated Mon, 31 Dec 2018 11:00:58 +0000