The Jurisdiction F, 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 was not complete or insufficient |
| 3 |
Additional records requested were not submitted by provider |
Service(s) Related to Top Errors
CPT® Codes: 93306, 93880, C8929, 80061, 71275, 74176, 84443
Educational Resources
Drugs and Biological Services
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted was not complete or insufficient |
| 2 |
Documentation submitted does not support medical necessity |
| 3 |
Documentation submitted did not support the number of units billed |
Service(s) Related to Top Errors
HCPCS Codes: J0897, J3111
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 does not support a covered diagnosis |
| 2 |
Documentation submitted does not support that the beneficiary needed preparation and preservation of compromised skin grafts |
| 3 |
Documentation submitted does not indicate that the beneficiary was unresponsive to typical medical and surgical management for chronic refractory osteomyelitis |
| 4 |
Documentation submitted does not support acute traumatic peripheral ischemia |
Educational Resources
Inpatient Rehabilitation Facility (IRF)
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted does not support the discharge status code billed on the claim |
Educational Resources
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 1, Section 110
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Sections 220-230.6
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 140
- CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4
- Inpatient Rehabilitation Facility (IRF) Documentation Requirements
Skilled Nursing Facility (SNF)
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted does not support the level of service shown on the claim. The HIPPS was recoded to reflect changes made to the MDS supported by submitted documentation |
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 |
Additional records requested were not submitted by provider |
| 3 |
Documentation submitted was not complete or insufficient |
Service(s) Related to Top Errors
CPT® Codes: 66984, 20553, 27130
Educational Resources
Outpatient Rehabilitation Services
| Top Errors |
Top Error Details |
| 1 |
Documentation submitted did not include treatment notes that had all required elements such as date of treatment, description of procedure that supported billing, total treatment minutes/total timed code treatment minutes or signature of qualified professional |
| 2 |
Documentation submitted did not support the units billed |
| 3 |
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 |
| 4 |
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
