Medical Review Quarterly Reports
Quarterly TPE Exclusion Rates:
Supplier results for all TPE reviews completed January 2024 - March 2024:
- 10 Claim Pilot – 47% Successfully Passed
- Round 1 – 70% Successfully Achieved Exclusion
- Round 2 – 60% Successfully Achieved Exclusion
- Round 3 – 61% Successfully Achieved Exclusion
Description | Error Rate (January 1 – March 31, 2024) | HCPCS |
---|---|---|
Ankle-Foot Orthoses (AFO) | 30.66% | L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397 and L4631 |
Blood Glucose Test Strips | 33.61% | A4253 |
Commodes | 39.43% | E0163 and E0165 |
Continuous Airway Positive Pressure (CPAP) | 21.56% | E0601 |
Enteral Nutrition | 32.35% | B4035 |
External Infusion Pumps | 13.04% | J1559, J1569, J1575 |
Hospital Beds | 15% | E0260, E0261, and E0303 |
Knee Orthoses | 55.88% | L1832, L1833, L1843, L1844, L1845, L1851, L1852, and L2397 |
Manual Wheelchairs | 35.24% | K0001-K0004 |
Nebulizers | 13.54% | J7605, J7606, J7613, J7620 and J7626 |
Oxygen and Oxygen Equipment | 35.79% | E0424, E0439, E1390 and E1391 |
Spinal Orthoses | 47.37% | L0450-L0651 |
Surgical Dressings | 52.89% | A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, and A6251-A6256 |
Therapeutic Shoes for Persons with Diabetes (TSPD) | 37.28% | A5500, A5512, and A5513 |
Urological Supplies | 28.52% | A4316, A4351, A4352, A4353, and A4355 |
Updated: 05.21.24