Medical Review Quarterly Reports
Quarterly TPE Exclusion Rates:
Supplier results for all TPE reviews completed July - September 2024:
- 10 Claim Pilot – 43% Successfully Passed
- Round 1 – 76% Successfully Achieved Exclusion
- Round 2 – 57% Successfully Achieved Exclusion
- Round 3 – 72% Successfully Achieved Exclusion
Quarterly Report | Error Rate (July 1 – September 30, 2024) | HCPCS Codes |
---|---|---|
Ankle-Foot Orthoses (AFO) | 30.42% | L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397, L4631 |
Commodes | 34.74% | E0163 and E0165 |
Continuous Airway Positive Pressure (CPAP) & Supplies | 18.44% | E0601, A7027 – A7034, A7044 |
Enteral Nutrition | 12.27% | B4035 |
External Infusion Pumps | 14% | J1559, J1569, J1575 |
Glucose Monitors & Supplies | 30.76% | E2103 & A4239 A4233-A4236, A4253, A4256, A4258, A4259, and E0607 |
Hospital Beds | 27.05% | E0260, E0261, and E0303 |
Immunosuppressive Drugs | 6.87% | J7503, J7507, J7518, J7520, and J7527 |
Knee Orthoses | 45.56% | L1832, L1843, L1844, L1845, L1851, L1852, and L2397 |
Manual Wheelchairs | 32.05% | K0001-K0004 |
Nebulizer Inhalation Drugs | 37.99% | J7605, J7606, J7613, J7620 and J7626 |
Oxygen and Oxygen Equipment | 12.92% | E0424, E0439, E1390 and E1391 |
Spinal Orthoses | 36.93% | L0450-L0651 |
Surgical Dressings | 44.14% | A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, and A6251-A6256 |
Therapeutic Shoes for Persons with Diabetes (TSPD) | 33.45% | A5500, A5512, and A5513 |
Urological Supplies | 25.90% | A4316, A4351, A4352, A4353, and A4355 |
Updated: 11.05.24