National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC), has completed a widespread prepayment review for positive airway pressure (PAP) devices (HCPCS E0601).
According to information released by the DME MAC, denials based on the 113 claims reviewed were as follows:
- No/insufficient medical record documentation of a face-to-face clinical evaluation for obstructive sleep apnea (OSA) by the treating physician;
- No/invalid order;
- No/insufficient medical record documentation by the treating physician indicating the beneficiary has a diagnosis of OSA and continues to use PAP device;
- No/insufficient report of a Medicare-covered sleep study;
- No/insufficient documentation that the beneficiary/caregiver has received instructions on proper care of the PAP device; and
- No/insufficient proof of delivery.