Positive Airway Pressure (PAP) Devices 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) E0601. The quarterly edit effectiveness results from October – December 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 17%.

Top Denial Reasons

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

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

Last Updated Mar 05, 2019