Enteral Nutrition - Targeted Probe and Educate Results

The Jurisdiction D, DME MAC, Medical Review Department conducted a Targeted Probe and Educate (TPE) review of HCPCS code(s) B4150, B4152, and B4154. The quarterly edit effectiveness results from July 2024 - September 2024 show the overall claim potential improper payment rate is 20%. The top medical necessity denial reasons include:

  • Medical record documentation does not support enteral nutrition is required to maintain weight and strength commensurate with the beneficiary’s overall health status.
  • Medical record documentation does not support either a full or partial non-function or disease of the structures that normally permit food to reach the small bowel; OR, disease that impairs digestion and/or absorption of an oral diet, directly or indirectly, by the small bowel.

Refer to the Medical Record Review Results page for more information.

Last Updated Feb 06 , 2025