Medical Review Quarterly Reports
Quarterly TPE Exclusion Rates:
Supplier results for all TPE reviews completed October 2023 - December 2023:
- 10 Claim Pilot – 12% Successfully Passed
- Round 1 – 37% Successfully Achieved Exclusion
- Round 2 – 33.3% Successfully Achieved Exclusion
- Round 3 – 29% Successfully Achieved Exclusion
Quarterly Report | Error Rate (October – December 31 2023) | HCPCS Codes |
---|---|---|
Ankle-Foot Orthoses (AFO) | 34.53% | L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397, L4631 |
Blood Glucose Test Strips | 41.85% | A4253 |
Commodes | 43.03% | E0163 and E0165 |
Continuous Airway Positive Pressure (CPAP) | 25.88% | E0601 |
Enteral Nutrition | 24.32% | B4035 |
External Infusion Pumps | 13.33% | J1559, J1569 and J1575 |
Hospital Beds | 14.71% | E0260, E0261, and E0303 |
Immunosuppressive Drugs | 8.57% | J7503, J7507, J7518, J7520, and J7527 |
Knee Orthoses | 88.20% | L1832, L1833, L1843, L1844, L1845, L1851, L1852, and L2397 |
Manual Wheelchairs | 41.43% | K0001-K0004 |
Nebulizer Inhalation Drugs | 31.61% | J7605, J7606, J7613, J7620 and J7626 |
Oxygen and Oxygen Equipment | 31.35% | E0424, E0439, E1390 and E1391 |
Spinal Orthoses | 71.35% | L0450-L0651 |
Surgical Dressings | 36.62% | A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, and A6251-A6256 |
Surgical Dressings – GW Modifier | 100% | A4452, A6213, A6219, A6222 and A6446 |
Therapeutic Shoes for Persons with Diabetes (TSPD) | 51.87% | A5500, A5512, and A5513 |
Urological Supplies | 33.71% | A4316, A4351, A4352, A4353, and A4355 |
Updated: 03.18.24