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Medical Review Quarterly Reports

Quarterly TPE Exclusion Rates:

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

  • 10 Claim Pilot – 42% Successfully Passed
  • Round 1 – 75% Successfully Achieved Exclusion
  • Round 2 – 56% Successfully Achieved Exclusion
  • Round 3 – 60% Successfully Achieved Exclusion
Quarterly Report Error Rate (April 1 – June 31, 2024) HCPCS Codes
Ankle-Foot Orthoses (AFO) 32.32% L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397, L4631
Commodes 32.89% E0163 and E0165
Continuous Airway Positive Pressure (CPAP) & Supplies 18.42% E0601, A7027 – A7034, A7044
Enteral Nutrition 15.34% B4035
Glucose Monitors & Supplies 31.98% E2103 & A4239
A4233-A4236, A4253, A4256, A4258, A4259, and E0607
Hospital Beds 50% E0260, E0261, and E0303
Knee Orthoses 36.68% L1832,  L1843, L1844, L1845, L1851, L1852, and L2397
Manual Wheelchairs 41.61% K0001-K0004
Nebulizer Inhalation Drugs 28.86% J7605, J7606, J7613, J7620 and J7626
Oxygen and Oxygen Equipment 17.30% E0424, E0439, E1390 and E1391
Spinal Orthoses 48.95% L0450-L0651
Surgical Dressings 48.54% A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, and A6251-A6256
Therapeutic Shoes for Persons with Diabetes (TSPD) 50.92% A5500, A5512, and A5513
Urological Supplies 25.88% A4316, A4351, A4352, A4353, and A4355

Updated: 08.07.24

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