Immunosuppressive Drugs Pre-Pay Review Quarterly Status Report
Below is the analysis of claim denials for immunosuppressive drugs HCPCS codes J7503, J7507, J7518, J7520, and J7527 reviewed between October 1 and December 31, 2023. The error rate for this quarter is 4.35%. All claims denied for this reason:
Rank | Reason | Percent |
---|---|---|
1. | The claim is billed for greater quantity than the order indicates. Refer to Medicare Program Integrity Manual 100-08, Chapter 5, Section 5.2 , Immunosuppressive Drugs – LCD (L33824), and Immunosuppressive Drugs – Policy Article (A52474). | 100.00% |
*The total percentage will be greater than 100% because some claims were denied for multiple reasons.
**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to represent an overall error rate for the HCPCS code or policy under medical record review.
Resources:
- Immunosuppressive Drugs – LCD (L33824)
- Immunosuppressive Drugs – Policy Article (A52474)
- Immunosuppressive Drug Medical Review Resources
Updated: February 2, 2024