Manual Wheelchair 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) K0001 and K0003. The quarterly edit effectiveness results from October – December 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 29%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Documentation does not support coverage criteria for a lightweight wheelchair.
  • Documentation does not support medical necessity.

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

            Last Updated Tue, 05 Mar 2019 10:24:38 +0000