Medical Review Quarterly Reports
Quarterly TPE Exclusion Rates:
Supplier results for all TPE reviews completed October 2023 – December 2023:
- 10 Claim Pilot – 8.5% Successfully Passed
- Round 1 – 38.4% Successfully Achieved Exclusion
- Round 2 – 36.5% Successfully Achieved Exclusion
- Round 3 – 34.7% Successfully Achieved Exclusion
Description | Error Rate (October – December 31 2023) | HCPCS |
---|---|---|
Ankle-Foot Orthoses (AFO) | 36.59% | L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397 and L4631 |
Blood Glucose Test Strips | 38.31% | A4253 |
Commodes | 40.53% | E0163 and E0165 |
Continuous Airway Positive Pressure (CPAP) | 36.33% | E0601 |
Enteral Nutrition | 10.53% | B4035 |
Hospital Beds | 10.20% | E0260, E0261, and E0303 |
Immunosuppressive Drugs | 4.35% | J7503, J7507, J7518, J7520, and J7527 |
Knee Orthoses | 65.22% | L1832, L1833, L1843, L1844, L1845, L1851, L1852, and L2397 |
Manual Wheelchairs | 44.13% | K0001-K0004 |
Nebulizers | 30.65% | J7605, J7606, J7613, J7620 and J7626 |
Oxygen and Oxygen Equipment | 25.86% | E0424, E0439, E1390 and E1391 |
Spinal Orthoses | 56.99% | L0450-L0651 |
Surgical Dressings | 39.81% | A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, and A6251-A6256 |
Surgical Dressings – GW Modifier | 100.00% | A4452, A6213, A6219, A6222 and A6446 |
Therapeutic Shoes for Persons with Diabetes (TSPD) | 45.41% | A5500, A5512, and A5513 |
Urological Supplies | 30.81% | A4316, A4351, A4352, A4353, and A4355 |
Urological Supplies – GW Modifier | 100% | A4316, A4351, A4352, A4353 and A4355 |
Updated: 03.18.24