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Blood Glucose Test Strips Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for blood glucose test strips HCPCS code A4253 reviewed between January 1 and March 31, 2024. The error rate for this quarter is 33.61%. The top 10 reasons for claim denials are as follows:

Rank Reason Percent
1. We did not receive any medical record documentation. 34.84%
2. Medical Records and/or beneficiary testing logs do not meet the LCD requirements for billing high utilization amounts. 31.34%
3. The medical record documentation does not support the beneficiary had an in-person or Medicare-approved telehealth visit with their treating practitioner to assess adherence to their continuous glucose monitor (CGM) regimen and diabetes treatment plan every six months after the initial prescription of the CGM. 7.16%
4. Quantity of supplies ordered is above normal allowable amounts and no medical records were sent in to address the need for over-utilization. Medical records and a test log or narrative by the practitioner are required to support the requirements in the ‘high utilization' section of the Glucose Monitors LCD (L33822). 4.67%
5. The documentation does not have a valid Standard Written Order (SWO). 4.46%
6. There is not a valid handwritten or electronic signature by the author of the medical record. 3.36%
7. Claim history shows that the supplier has already been paid for all or a portion of the medically necessary supplies for this time span. Therefore, the excess units are denied. 2.26%
8. The KS modifier was incorrectly appended. The medical record documentation supports the beneficiary is insulin treated. 2.05%
9. Payment for supplies billed above normal policy usage is denied due to lack of documentation to support that they are reasonable and necessary. 1.90%
10. The medical record documentation does not support the beneficiary has diabetes. 1.53%

*The total percentage will be greater than 100% because some claims denied for multiple reasons.

**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to be an overall error rate for the HCPCS code or policy under medical record review.

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Updated: May 21, 2024

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