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Part A Medical Review Activity Log

Part A Prepayment

Edit Code Description Review Type Status Documentation Requirements Checklist
5TC3R Review of services related to non-covered services/Category III CPT code utilization Prepayment Review Active Non-covered Services/Category III CPT Code Utilization ADR Checklist
5042T Review of CPT code 0042T for services related to cerebral perfusion analysis using CT with contrast Prepayment Review Active Cerebral Perfusion Analysis Using CT with Contrast ADR Checklist

Part A Postpayment

Edit Code Description Review Type Status Documentation Requirements Checklist
51101 Review of HCPCS code G0277 for services related to Hyperbaric Oxygen Therapy (HBOT) Postpayment Review Active HBOT ADR Checklist

Part A Targeted Probe and Educate

Edit Code Description Review Type Status Documentation Requirements Checklist
5PE10 Review of HCPCS codes 66984, 66983, and 66982 for Cataract Removal Targeted Probe and Educate Prepayment Review Paused Cataract Extraction with IOL ADR Checklist
5PE11 Review of HCPCS code 62323 for Spinal Injections Targeted Probe and Educate Prepayment Review Paused Spinal Injections (ESI) ADR Checklist
5PE12 Review of HCPCS code 93798 for Cardiac Rehabilitation with continuous ECG Monitoring Targeted Probe and Educate Prepayment Review Paused Cardiac Rehab with Continuous ECG Monitoring ADR Checklist
5PE15 Review of Inpatient Claims for DRG 470 Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC Targeted Probe and Educate Prepayment Review Paused Major Joint ADR Checklist
5PE16 Review of Outpatient Claims for Pulmonary Rehabilitation HCPCS G0424 Targeted Probe and Educate Prepayment Review Paused Pulmonary Rehab ADR Checklist
5PE17 Review of Inpatient Claims for DRGs 456-460 Spinal Fusion Except Cervical With Spinal Curv/Malig/Infec or EXT FUS W/WO MCC and/or CC Targeted Probe and Educate Prepayment Review Paused Spinal Fusion ADR Checklist
5PE20 TPE Round 2 Review of HCPCS codes 66984, 66983, and 66982 for Cataract Removal Targeted Probe and Educate Prepayment Review Paused Cataract Extraction with IOL ADR Checklist
5PE21 TPE Round 2 Review of HCPCS code 62323 for Spinal Injections Targeted Probe and Educate Prepayment Review Paused Spinal Injection ADR Checklist
5PE22 TPE Round 2 Review of HCPCS code 93798 for Cardiac Rehabilitation with continuous ECG Monitoring Targeted Probe and Educate Prepayment Review Paused Cardiac Rehab with Continuous ECG Monitoring ADR Checklist
5PEPR Review of Outpatient Claims for Pulmonary Rehabilitation HCPCS G0424, TOB 85X Targeted Probe and Educate Prepayment Review Paused Pulmonary Rehab ADR Checklist
5PE25 Review of Inpatient Claims or DRG 470 Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC Targeted Probe and Educate Prepayment Review Paused Major Joint ADR Checklist
5PE26 Review of Outpatient Claims for Pulmonary Rehabilitation HCPCS G0424 Targeted Probe and Educate Prepayment Review Paused Pulmonary Rehab ADR Checklist
5PE40 Review of IRF CMGs 1404, 0108, 0107, 0104, 0105, 0106, 0109, 0703, 0602, 0902 Targeted Probe and Educate Prepayment Review Paused IRF ADR Checklist
5PE41 Review of services related to skilled nursing and/or therapy to determine utilization of the Provider Driven Payment Model (PDPM) Targeted Probe and Educate Prepayment Review Paused PDPM ADR Checklist

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