External Infusion Pumps Quarterly Results of Targeted Probe and Educate Review - JA DME
External Infusion Pumps Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) J1559 and J1569 as well as any additional codes on the claim for the related policy. The quarterly edit effectiveness results from October 2025 – December 2025 are as follows:
Based on dollars, the overall claim potential improper payment rate is 0%.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the External Infusion Pumps webpage to access coverage documents (Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD)); documentation letters, forms, and checklists; reviews; tips; tools; resources; related articles; and educational events and tutorials, if applicable.
See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.
