The Jurisdiction D, DME MAC, Medical Review Department is conducting Targeted Probe and Educate (TPE) reviews of HCPCS code K0001 as well as any additional codes on the claim for the related policy. The quarterly edit effectiveness results from July 2026 – September 2026 are as follows:

Based on dollars, the overall claim potential improper payment rate is 22%.

Top Denial Reasons

• Related item denied due to medical necessity.
• The documentation does not demonstrate Criterion B – the beneficiary’s mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker.
• The documentation does not demonstrate Criterion D – use of the manual wheelchair will significantly improve the beneficiary’s ability to participate in mobility related activities of daily living (MRADLs) and the beneficiary will use it on a regular basis in the home.

Educational Resources

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

See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.