| Providers in DC, DE, MD, NJ & PA | |
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All current topics for review are listed below with the Medical Review Part B schedule for each round. We will notify the selected providers in writing with further details of the topic being reviewed, the reasons for selection which will be supported by data analysis, and the process of review. Please note that a status of active review means there are currently reviews underway for the specific round and topic. A status of inactive review means there are currently no active TPE reviews for the specific round and topic. For additional information and specific educational resources, see the topic specific links below.
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End stage renal disease (ESRD) services (CPT 90960-90961) |
Active |
ESRD checklist |
ESRD results |
Rehabilitation services: Outpatient physical and occupational therapy (CPT 97530) |
Inactive |
Therapy checklist |
Therapy results |
Surgical services: Cataract extraction (CPT 66982-66984) |
Active |
Cataract checklist |
Cataract results |
Drugs and biologicals: Drug injections (HCPCS J0178 (Eylea), J2778 (Lucentis), J0717 (Cimzia), J7318, J7320, J7321 (Hyaluronan Acid Therapies) with associated administration and placement codes) |
Inactive |
Drug injection checklist |
Drug Injection results |
Psychiatric services: Psychotherapy (CPT 90832, 90834, and 90837) |
Active |
Psychotherapy checklist |
Psychotherapy results |
Mohs micrographic surgery (MMS) (CPT 17311-17315) |
Inactive |
MMS checklist |
MMS results |
Nail cutting/Paring and debridement (CPT 11719-11721, 11055-11057, HCPCS G0127) |
Active |
Foot care checklist |
Foot care results |
Anesthesia services: Anesthesia for diagnostic or therapeutic injections; prone position (CPT 01992) |
Active |
Anesthesia checklist |
Anesthesia results |
Trigger point injections (CPT 20552-20553) |
Active |
Trigger point injection checklist |
Trigger point injection results |
Paravertebral facet joint injections (CPT 64490-64491) |
Inactive |
Facet joint injection checklist |
Facet joint injection results |
Epidural steroid injections for pain management (CPT 62323) |
Active |
Epidural steroid injection checklist |
Epidural steroid injection results |
Rehabilitation services: Outpatient physical, occupational and speech therapy services billed with KX modifier |
Inactive |
Therapy checklist |
Therapy KX Results |
Drugs and biologicals: Drug injections (Hyaluronan Acid Therapies) (HCPCS J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332) |
Active |
Drugs, biologicals and injection services checklist |
Coming soon |
Removal of benign skin lesions (CPT 11102-11103, 11200-11201, 11300-11303, 11305-11313 and 11401-11406, 11421-11424, 11426, 11440-11446) |
Active |
Skin lesion removal checklist |
Coming soon |
Laboratory services: Definitive drug testing (HCPCS: G0480, G0481, G0482, G0483) |
Active |
Laboratory services checklist |
Coming soon |
Acupuncture (CPT 97810-97811; 97813-97814) |
Active |
Acupuncture checklist |
Coming soon |
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