Enteral Nutrition Targeted Probe and Educate (TPE) Review

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 Enteral Nutrition Quarterly Results of Targeted Probe and Educate Review on the Noridian Medicare website for the most recent results.

Last Updated Mar 11 , 2025