Oxygen and Oxygen Equipment 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) E0424, E0431, E0434, E0439 and E1390. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 45%.

Top Denial Reasons

  • Documentation does not support coverage criteria
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Documentation does not support a qualifying blood gas study

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


            Last Updated Mon, 31 Dec 2018 11:55:25 +0000