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