Oxygen and Oxygen Equipment Quarterly Results of Targeted Probe and Educate Review - JD DME
Oxygen and Oxygen Equipment 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) E0424, E0431, E1390 and E1392. The quarterly edit effectiveness results from January 2025 – March 2025 are as follows:
Based on dollars, the overall claim potential improper payment rate is 16%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not include a blood gas study.
- Blood gas study obtained during exercise does not include testing during exercise with oxygen applied to demonstrate the improvement of the hypoxemia.
- Medical record documentation does not support that the qualifying blood gas study was performed at the time of need.
Top Technical Denial Reasons
- Standard written order (SWO) contains an error for a reason not otherwise specified.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Oxygen 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.
