Skip to Main Content

Print | Bookmark | Email | Font Size: + |

Medical Review Quarterly Reports

Quarterly TPE Exclusion Rates:

Supplier results for all TPE reviews completed January 2024 - March 2024:

  • 10 Claim Pilot – 48% Successfully Passed
  • Round 1 – 60% Successfully Achieved Exclusion
  • Round 2 – 61% Successfully Achieved Exclusion
  • Round 3 – 48% Successfully Achieved Exclusion
Quarterly Report Error Rate (January 1 – March 31, 2024) HCPCS Codes
Ankle-Foot Orthoses (AFO) 32.87% L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397, L4631
Blood Glucose Test Strips 40.72% A4253
Commodes 32.98% E0163 and E0165
Continuous Airway Positive Pressure (CPAP) 21.49% E0601
Enteral Nutrition 18.86% B4035
External Infusion Pumps 6.11% J1559, J1569 and J1575
Hospital Beds 13.80% E0260, E0261, and E0303
Immunosuppressive Drugs 17.39% J7503, J7507, J7518, J7520, and J7527
Knee Orthoses 67.82% L1832, L1833, L1843, L1844, L1845, L1851, L1852, and L2397
Manual Wheelchairs 35.81% K0001-K0004
Nebulizer Inhalation Drugs 25.98% J7605, J7606, J7613, J7620 and J7626
Oxygen and Oxygen Equipment 32.80% E0424, E0439, E1390 and E1391
Spinal Orthoses 57.42% L0450-L0651
Surgical Dressings 49.19% A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, and A6251-A6256
Therapeutic Shoes for Persons with Diabetes (TSPD) 52.28% A5500, A5512, and A5513
Urological Supplies 22.75% A4316, A4351, A4352, A4353, and A4355

Updated: 05.21.24

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved