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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

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