Urological Supplies Targeted Probe and Educate Review Updates: January - March 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 January - March 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 43%.

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.

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


Last Updated Jun 27, 2019