Targeted probe and educate (TPE) round results: Wound debridement (CPT 11042-11045)
Top denial / partial denial reasons and high-level results are listed below from each round of Wound debridement TPE reviews...
Part B service-specific review – drugs and biologicals (J0178 Eylea, J0897 Prolia, J2778 Lucentis, J9217 Lupron (Leuprolide))
Summary for drugs and biologicals (April-May 2021).
Part A service-specific review -- (CPT 97530 therapeutic activities)
Summary for outpatient rehabilitation services (January through August 2021)
Clinical trials background
Medicare covers the routine costs of qualifying clinical trials, as such costs are defined in National Coverage Determination...
Part A service-specific review -- (CPT 97110 therapeutic activities)
Summary for outpatient rehabilitation services (August - November 2020).
Part A service-specific review -- hyperbaric oxygen therapy (G0277)
Summary for outpatient rehabilitation services (December 2020).
Part B service-specific review -- outpatient rehabilitation services (CPT code 97110)
Summary for outpatient rehabilitation services (August - November 2020 and August 2021).
Part B service-specific review -- hyperbaric oxygen therapy (CPT code 99183)
Summary for hyperbaric oxygen therapy (October 2020).
Part B service-specific review - ambulance services (HCPCS code A0428 with A0425)
Summary for ambulance services (October 2020).
Humanitarian device exemption
First Coast may consider coverage of a humanitarian use device, intended to benefit a small patient population, when the...