Positive Airway Pressure (PAP) Devices Targeted Probe and Educate Review Updates: April - June 2018

The Jurisdiction D, DME MAC, Medical Review Department is conducting a targeted probe and educate review of HCPCS code E0601. The quarterly edit effectiveness results from April 2018 - June 2018 are as follows:

  • Based on dollars, the overall claim potential improper payment rate is 12%.

Top Denial Reasons

  • Documentation does not support coverage criteria.
  • Documentation does not support a qualifying sleep test.
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • The medical record documentation contains an error.

For complete detail see, Positive Airway Pressure (PAP) Devices Quarterly Results of Targeted Probe and Educate Review.

Last Updated Aug 10, 2018