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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

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