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 as well as any additional codes on the claim for the related policy. The quarterly edit effectiveness results from July 2025 – September 2025 are as follows:

Based on dollars, the overall claim potential improper payment rate is 24%.

Top Medical Necessity Denial Reasons

  • The medical record does not include documentation by the treating practitioner of the medical necessity of a pneumatic compression device including the patient’s diagnosis and prognosis; symptoms and objective findings, including measurements which establish the severity of the condition; the reason the device is required, including the treatments which have been tried and failed; and the clinical response to an initial treatment with the device.
  • The medical record documentation does not include a four-week trial of conservative therapy which supports there has been no significant improvement or if significant symptoms remain after the trial.
  • The medical record does not include symptoms and objective findings, including measurements which establish the severity of the condition.

Top Technical Denial Reasons

  • The supply or accessory is denied as the base equipment is denied. Refer to applicable Local Coverage Determination/Policy Article.
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.

Educational Resources

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the PCD 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 Oct 28 , 2025