Osteogenesis Stimulators 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 codes E0747, E0748 or E0760. The quarterly edit effectiveness results from September 2021 - December 2021 are as follows:

Based on dollars, the overall claim potential improper payment rate is 17%.

Top Medical Necessity Denial Reasons

  • N/A

Top Technical Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Medical record documentation is dated after the date of service. Refer to A55426.
  • Claim is a duplicate to a previously submitted claim.

Educational Resources

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Osteogenesis Stimulator 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 Wed, 09 Feb 2022 17:37:21 +0000