Pre-Payment Review Results for Ocrevus for Q3 2025

Published 10/30/2025

Pre-Payment Review Results for Ocrevus® (Ocrelizumab) for Targeted Probe and Educate (TPE) for July through September 2025

The Centers for Medicare & Medicaid Services (CMS) implemented the TPE process for Healthcare Common Procedure Coding System (HCPCS) code J2350 for Ocrevus® (Ocrelizumab). The reviews with edit effectiveness are presented here for North Carolina, South Carolina, Virginia and West Virginia. 

Cumulative Results

Table 1. Cumulative Results.

 Number of Providers with Edit Effectiveness

Providers Compliant Completed/Removed After Probe

Providers Non-Compliant Progressing to Subsequent Probe

Providers Non-Compliant/Removed for Other Reason

3 3 0 0
Table 2. Cumulative Results.

Number of Claims with Edit Effectiveness

Number of Claims Denied

Overall Claim Denial Rate

Total Dollars Reviewed

Total Dollars Denied

Overall Charge Denial Rate

61

0

0%

$1,958,897.99

$0

0%

Probe One Findings

Table 3. Probe One Findings.

State

Number of Providers with Edit Effectiveness

Providers Compliant Completed/Removed After Probe

Providers Non-Compliant Progressing to Subsequent Probe

Providers Non-Compliant/Removed for Other Reason

N.C. 1 1 0 0
S.C. 0 0 0 0
Va. 2 2 0 0
W.Va. 0 0 0 0
Table 4. Probe One Findings.

State

Number of Claims with Edit Effectiveness

Number of Claims Denied

Overall Claim Denial Rate

Total Dollars Reviewed

Total Dollars Denied

Overall Charge Denial Rate

N.C. 16 0 0% $541,877.99 $0 0%
S.C. 0 0 0% $0 $0 0%
Va. 45 0 0% $1,417,020.00 $0 0%
W.Va. 0 0 0% $0 $0 0%

Risk Category

The categories for HCPCS code J2350 for Ocrevus® (Ocrelizumab) are defined as:

Table 5. Risk Category.
Risk Category Error Rate
Minor 0–20%
Major 21–100%

Figure 1. Risk Category for Ocrevus® (Ocrelizumab) HCPCS Code J2350.

Pie Chart showing 0 percent major and 100 percent minor.

Education
Palmetto GBA offers providers selected for TPE an individualized education session to discuss each claim denial. This is an opportunity to learn how to identify and correct claim errors. A variety of educational methods are offered such as webinar sessions, web-based presentations and teleconferences. Other education methods may also be available. Providers do not have to be selected for TPE to request education. If education is desired, please complete the Education Request Form (PDF).

Next Steps
Providers found to be non-compliant (major risk category/denial rate of 21–100 percent) at the completion of TPE Probe 1 will advance to Probe 2, and providers found to be non-compliant (major risk category/denial rate of 21–100 percent) at the completion of TPE Probe 2 will advance to Probe 3 of TPE after at least 45 days from completing the 1:1 post-probe education call date. 


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