The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A6021, A6212, A6196 and A6197. The quarterly edit effectiveness results from January - March 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 82%.

Top Denial Reasons

• Documentation does not support coverage criteria.
• Refill request documentation is incomplete or missing elements.

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