National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC), Medical Review Department, wrapped up its review of claims for CPAP devices (HCPCS code E0601KH).
Of the 314 reviewed claims, 61 were allowed as billed and 197 were denied.
According to the DME MAC:
- 134 of these claims were denied for insufficient or no medical record documentation of a face-to-face clinical evaluation for obstructive sleep apnea from the treating physician.
- 88 of these claims were denied for insufficient or no report of a Medicare-covered sleep study.
- 56 of these claims were denied because the supplier did not respond to the additional documentation request.