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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 – 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

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