Urological Supplies Targeted Probe and Educate Review Updates: April - June 2019

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A4351, A4353, and A4358. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 37%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Documentation does not support coverage criteria
  • Claim is billed for greater quantity than the Detailed Written Order (DWO) indicates
  • Detailed Written Order (DWO) is incomplete or missing elements

For complete detail see, Urological Supplies Quarterly Results of Targeted Probe and Educate Review

Last Updated Oct 28, 2019