Manual Wheelchair Quarterly Results of Targeted Probe and Educate Review

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) K0001 and K0003 as well as any additional codes on the claim for the related policy. The quarterly edit effectiveness results from October 2025 - December 2025 are as follows:

Based on dollars, the overall claim potential improper payment rate is 16%.

Top Medical Necessity Denial Reasons

  • The documentation does not demonstrate criterion C - the beneficiary’s home provides adequate access between rooms, maneuvering space and surfaces for use of the manual wheelchair that is provided.
  • Related item denied due to medical necessity.
  • The documentation does not demonstrate criterion A - the beneficiary has a mobility limitation which significantly impairs their ability to participate in mobility related activities of daily living (MRADL) within their home.

Top Technical Denial Reasons

  • The documentation does not include a Standard Written Order (SWO).
  • Related item denied due to invalid order.
  • Supplier indicates the item(s) were billed in error.

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.

Last Updated Jan 28 , 2026