Positive Airway Pressure (PAP) Devices Targeted Probe and Educate Review Updates: January - March 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 January - March 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 18%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Documentation does not support coverage criteria.

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

 

Last Updated Jun 27, 2019