Pneumatic Compression Devices Quarterly Results of Targeted Probe and Educate Review - JD DME

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0651. The quarterly edit effectiveness results from July 2024 - September 2024 are as follows:

Based on dollars, the overall claim potential improper payment rate is 54%.

Top Medical Necessity Denial Reasons

• Licensed/certified medical professional (LCMP) assessment does not have evidence of concurrence or disagreement by the treating physician/practitioner.
• Documentation does not demonstrate the licensed/certified medical professional (LCMP) does not have a financial relationship with the supplier.
• Medical record does not include the clinical response to an initial treatment with the device.

Top Technical Denial Reasons

• Documentation was not received in response to the Additional Documentation Request (ADR) letter.
• Supply or accessory is denied as the base equipment is denied. Refer to applicable Local Coverage Determination/Policy Article.
• Beneficiary was in an acute care hospital or skilled nursing facility on this date of service. Refer to Medicare Claims Processing Manual 100-04, Chapter 20, Sections 210-212.

Educational Resources

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Pneumatic Compression Devices 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.