The Jurisdiction E, Part A Medical Review Department has identified the following top trending errors through ongoing claim review activities from July 1, 2026 through September 30, 2026. These findings are shared to promote provider awareness and support compliance with Medicare coverage, coding, and documentation requirements. Addressing these common findings may help reduce claim denials, improve claim submission accuracy, and promote appropriate payment of covered services.
Diagnostic Services
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted does not support medical necessity |
| 2 |
Documentation submitted did not include a signed order from the physician, or intent to order |
| 3 |
Documentation submitted did not support medical necessity outlined in the MACs LCD |
Service(s) Related to Top Errors
CPT® Codes: 84466, 75571, 80061, 84443, 74176, 71045, 71046, 82306
Educational Resources
Drugs and Biological Services
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted did not support the number of units billed |
| 2 |
Documentation submitted was not complete or insufficient |
| 3 |
Documentation submitted does not support medical necessity |
Service(s) Related to Top Errors
HCPCS Codes: J2802, J3300, J0666, J9271, Q5106
Educational Resources
- Billing and Coding Article: JW and JZ Modifier Billing Guidelines (A53024)
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 230.2B
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 17
- Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently Asked Questions
- Browse By Topic: Drugs, Biologicals and Injections
- Drugs, Biologicals and Injections Documentation Requirements
Hyperbaric Oxygen Therapy (HBOT)
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted is insufficient to support soft tissue radionecrosis |
| 2 |
Documentation submitted is insufficient to support diabetic wound classified Wagner grade III or higher |
| 3 |
Documentation submitted is insufficient to support lower extremity wound due to diabetes |
| 4 |
Documentation submitted is insufficient to support the beneficiary failed an adequate course of standard wound therapy for diabetic wound management |
Educational Resources
Nerve Injection Services
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted did not support medical necessity outlined in the MACs LCD |
| 2 |
Documentation submitted did not support the claim as billed |
| 3 |
Documentation submitted did not support the service billed as being rendered |
Service(s) Related to Top Errors
- CPT® Code: 64483
- HCPCS Code: G0260
Educational Resources
Skilled Nursing Facility (SNF)
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted did not support that the beneficiary required skilled nursing services that could only be performed or managed by qualified nursing personnel |
| 2 |
Documentation submitted did not meet requirements for recertification for the SNF stay |
| 3 |
The certification or recertification for the SNF stay was not signed timely, and documentation did not include reason for delayed certification |
Educational Resources
- CMS IOM, Publication 100-01, Medicare General Information, Eligibility, and Entitlement, Chapter 4
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 8
- CMS IOM, Publication100-04, Medicare Claims Processing Manual, Chapter 6
- CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 6, Section 6.1
- Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual
- Browse by Provider Type: Skilled Nursing Facility (SNF)
- Skilled Nursing Facility (SNF) Documentation Requirements
Surgical Services
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted did not support medical necessity outlined in the MACs LCD |
| 2 |
Documentation submitted was not complete or insufficient |
| 3 |
Additional records requested were not submitted by provider |
Service(s) Related to Top Errors
CPT® Codes: 66982, 66984, 27447, 27130
Educational Resources
Outpatient Rehabilitation Services
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted did not support the initial plan of care was certified by the physician/NPP, and there was no evidence of delayed certification or attempts to obtain certification from the physician/NPP |
| 2 |
Documentation submitted did not support the units billed |
| 3 |
Documentation submitted did not support the plan of care was recertified during the prior plan or care, or within 90 days |
Service(s) Related to Top Errors
- Physical Therapy (Revenue Code 042X)
- Occupational Therapy (Revenue Code 043X)
Educational Resources
