OIG audit finds that a Central Texas DME provider incorrectly used “miscellaneous” billing code

The Texas OIG audited Travis Medical Sales Corporation, a DME provider in Central Texas, based on data analysis showing the company received $1.5 million for DME items billed under the HCPCS miscellaneous code E1399 during 2023 and 2024. HCPCS instructs DME providers to use E1399 only when no other code adequately describes the device, and excessive use of this code can indicate improper billing. The OIG tested a sample of 392 DME items. For one item, a separate, more specific HCPCS code existed that Travis Medical was required to use instead of E1399; use of the miscellaneous code for that item resulted in an overpayment of $1,832.08 to be repaid to the State of Texas. For 62 of the 392 tested items (15.8%), Travis Medical's prescribing provider orders did not meet all required elements. Texas Medicaid DME billing requirements mandate that prescribing provider orders include documentation that a physician or allowed practitioner saw the patient within six months prior to delivery, and that the order be signed by a physician or allowed practitioner no more than 90 days before delivery. The OIG identified three distinct categories of documentation deficiencies across the 62 noncompliant items. The OIG attributed the documentation failures to Travis Medical's lack of an effective internal process to validate compliance with prescribing provider order requirements. Travis Medical provided the OIG with corrective action plans targeting resolution by November 2026.