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 January 2024 - March 2024 are as follows:

Based on dollars, the overall claim potential improper payment rate is 45%.

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 documentation does not include a four-week trial of conservative therapy demonstrating failed response to treatment is required.

Top Technical Denial Reasons

  • Supply or accessory is denied as the base equipment is denied.
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Claim submitted is a duplicate to another claim billed.

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.

Last Updated Apr 24 , 2024