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 July 1 – September 30, 2024. The error rate for this quarter is 6.87 %. The top 4 reasons for claim denials are as follows:
| Rank | Reason | Percent |
|---|---|---|
| 1. | The documentation does not have a valid standard written order. | 262.50% |
| 2. | The documentation is incomplete. | 12.50% |
| 3. | The supplier billed for greater quantity than the order shows. | 12.50% |
| 4. | Documentation does not include information that supports that the beneficiary had a Medicare approved transplant. | 12.50% |
*The total percentage will be greater than 100% because some claims 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 be an overall error rate for the HCPCS code or policy under medical record review.
Resources:
- Immunosuppressive Drugs Documentation Checklist

- Immunosuppressive Drugs – LCD (L33824)

- Immunosuppressive Drugs – Policy Article (A52474)

- Immunosuppressive Drug Medical Review Resources
Updated: November 5, 2024

