Positive Airway Pressure (PAP) Devices Targeted Probe and Educate Review Updates: April - June 2019

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0601. The quarterly edit effectiveness results from April - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 13%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Written Order Prior to Delivery (WOPD) is incomplete or missing elements
  • Detailed Written Order (DWO) is incomplete or missing elements

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

Last Updated Oct 28, 2019