Skip to Main Content

Print | Bookmark | Email | Font Size: + |

Medical Review Quarterly Reports

Quarterly TPE Exclusion Rates:

Supplier results for all TPE reviews completed April 2024 - June 2024:

  • 10 Claim Pilot – 43% Successfully Passed
  • Round 1 – 76% Successfully Achieved Exclusion
  • Round 2 – 57% Successfully Achieved Exclusion
  • Round 3 – 72% Successfully Achieved Exclusion
Description Error Rate (April 1 – June 30, 2024) HCPCS
Ankle-Foot Orthoses (AFO) 29.50% L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397 and L4631
Commodes 35.58% E0163 and E0165
Continuous Airway Positive Pressure (CPAP) & Supplies 17.41% E0601, A7027 – A7034, and A7044
Enteral Nutrition 12.88% B4034 and B4035
Glucose Monitors & Supplies 30.86% E2103, A4239, A4253
Hospital Beds 22.41% E0260, E0261, and E0303
Knee Orthoses 52.38% L1832, L1843, L1844, L1845, L1851, L1852, and L2397
Manual Wheelchairs 54.42% K0001-K0004
Nebulizers 19.17% J7605, J7606, J7613, J7620 and J7626
Oxygen and Oxygen Equipment 21.43% E0424, E0439, E1390 and E1391
Spinal Orthoses 53.59% L0450-L0651
Surgical Dressings 50.74% A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, and A6251-A6256
Therapeutic Shoes for Persons with Diabetes 46.26% A5500, A5512, and A5513
Urological Supplies 32.26% A4316, A4351, A4352, A4353, and A4355

Updated: 08.06.24

spacer

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