Article Detail - JD DME

Through the Targeted Probe and Educate (TPE) program, Noridian has identified the top medical necessity denial reasons for pneumatic compression devices (PCD):

• Medical record documentation does not include a four-week trial of conservative therapy demonstrating a failed response to treatment.
• The medical record does not include documentation by the treating practitioner of the medical necessity of a pneumatic compression device, including the patient’s diagnosis and prognosis; symptoms and objective findings, including measurements that establish the severity of the condition; the reason the device is required, including the treatments that have been tried and failed; and the clinical response to an initial treatment with the device.
• The medical record does not include the clinical response to an initial treatment with the device.

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Pneumatic Compression Devices (PCD) webpage to access coverage documents such as Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD), documentation letters, forms, checklists, reviews, tips, tools, resources, related articles; and educational events and tutorials, if applicable.