Pneumatic Compression Devices Quarterly Results of Targeted Probe and Educate Review - JD DME
Pneumatic Compression Devices (PCD) 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) E0651. The quarterly edit effectiveness results from April 2024 - June 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 33%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not include a four-week trial of conservative therapy demonstrating failed response to treatment is required.
- Medical record does not support the lymphedema is documented to be unresponsive to other clinical treatment over the course of a required four-week trial.
- Medical record does not include symptoms and objective findings, including measurements which establish the severity of the condition.
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.
- Documentation submitted indicates the item(s) were returned by the beneficiary.
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.
