Parenteral 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) B4185, B4193, B4197, and B4199. The quarterly edit effectiveness results from July 2024 - September 2024 show the overall claim potential improper payment rate is 14%. The top medical necessity denial reasons include:

  • Medical record documentation of the treating practitioner does not demonstrate that enteral nutrition has been considered and ruled out, tried, and been found ineffective, or that EN exacerbates gastrointestinal tract dysfunction.
  • Medical record documentation does not demonstrate the beneficiary has a permanent impairment that will be of long and indefinite duration.
  • Medical record documentation does not demonstrate the beneficiary has a) a condition involving the small intestine and/or its exocrine glands which significantly impairs the absorption of nutrients or b) disease of the stomach and/or intestine which is a motility disorder and impairs the ability of nutrients to be transported through the GI system.

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

Last Updated Feb 04 , 2025