Spinal Orthoses 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) L0625, L0626, L0627, L0630, L0631, L0637, L0641, L0642, L0643, L0648 and L0650. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 51%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Claim is the same or similar to another claim on file
  • Documentation does not include verification that the equipment was lost, stolen or irreparably damaged in a specific incident
  • The medical record documentation does not include Medicare approved interactive audio and video telecommunications systems to document the beneficiary's current condition

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


Last Updated Dec 31, 2018