Targeted probe and educate (TPE) round results: Surgical services - cataract extraction (CPT 66982-66984)

Top denial / partial denial reasons and high-level results are listed below from each round of cataract extraction TPE reviews that have been conducted thus far by First Coast. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. Additional rounds of review will be utilized when the targeted topic demonstrates a continued need for review with newly identified providers.

Top denial / partial denial reasons

The most common reasons for denial or partial denials are the following:

• Medical necessity – The documentation submitted does not support medical necessity as listed in coverage requirements.
• Insufficient documentation – Insufficient documentation was provided to support the services as billed to Medicare. First Coast Medical Review makes multiple attempts to correct these error types before completion of the review. Below are the following denial reasons for insufficient documentation that we were not able to resolve:
  • Documentation lacked evidence to support the requirements of the LCD.
  • Documentation did not support an eye examination was performed prior to cataract surgery.
  • Documentation was not submitted in a timely manner to support the services billed to Medicare.

Round results