Urological Supplies Targeted Probe and Educate Review: January - March 2018 Results

The Jurisdiction D, DME MAC, Medical Review Department is conducting a targeted probe and educate reviews of HCPCS code(s) A4351, A4353 and A4358.

Based on dollars, the overall claim potential improper payment rate is 33%.

Top Denial Reasons

Documentation was not received in response to the Additional Documentation Request (ADR) letter.

  • Documentation does not support coverage criteria.
  • Refill request documentation is incomplete or missing elements.
  • No medical record documentation was received. Refer to CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section

For complete details, see the Urological Supplies Quarterly Results of Targeted Probe and Educate Review webpage.

Last Updated Jun 07, 2018