DME MACs Release New TPE Results

What You Need to Know

The DME MACs have released their July-September 2025 TPE results for different  categories of bracing products.

The DME MACs’ Targeted Probe and Educate (TPE) program focuses on (a) items with high claim error rates, and (b) suppliers with high denial rates or billing practices that differ significantly from their peers. The program offers up to three rounds of prepayment claim reviews combined with individualized education after each round. The goal is to reduce claim errors and prevent improper payments by ensuring suppliers understand and adhere to coverage, coding, and documentation requirements.

The Q3 claim error rate for each of the three categories was:

Region A

Spinal Orthoses - n/a

Knee Orthoses - 61%

AFOs/KAFOs - 24%

Region B

Spinal Orthoses - 59.9%

Knee Orthoses - 52.5%

AFOs/KAFOs - 24.2%

Region C

Spinal Orthoses - 28.3%

Knee Orthoses - 28.3%

AFOs/KAFOs - 23.9%

Region D

Spinal Orthoses - n/a

Knee Orthoses - 79%

AFOs/KAFOs - n/a

 What This Means for You

As the chart above shows, different MACs focus on different bracing categories, with Regions B and C reviewing a wider range of devices than Regions A and D. 

There is wide variability between different regions' results, with knee orthoses having a claim error rate of only 28.3% in Region C all the way up to a high of 79% in Region D. Higher claim error rates in a particular region would likely lead to continued TPE activity there for those devices. 

If you want to see the most common reasons for claim denials of the various product categories by Region, click on the following links: Region A; Region B; Region C; Region D. 

Lastly, getting out of a TPE as quickly as possible is important for your business. Each TPE round requires you to submit 20-40 claims for review by the DME MAC. Passing the TPE review in the first round decreases the administrative burden on your company. Moreover, once you've passed a TPE review, the MACs cannot perform another TPE for that product category for 12 months. Alternatively, if you fail three consecutive rounds of TPE review, the DME MACs can recoup past payments, move you to 100% pre-payment claim review, or refer you for further investigation. So review your claims documentation processes now and fix any identified issues so that if you receive a TPE notice, you're in the best possible position to succeed on the first batch of claims reviewed.