Therapeutic Administration Services Targeted Probe and Educate Review Results - JE Part A
Therapeutic Administration Services Targeted Probe and Educate Review Results
The Jurisdiction E, Part A Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of therapeutic administration services. The findings of the claims reviewed from January 1, 2025 through March 31, 2025 are as follows:
Review Results
- 99 claims were reviewed with 7.7% error rate
Top Trending Errors
- Incorrect billing and coding of CPT code
- Missing documentation to support services rendered
Educational Resources
- Documentation Requirements
- IOM, Publication 100-08, Medicare Program Integrity Manual (MPIM), Chapter 3
- IOM, Publication 100-02, Medicare Benefit Policy Manual (MBPM), Chapter 15, Section 50
- IOM, Publication 100-04, Medicare Claims Processing Manual (MCPM), Chapter 4, Section 230.2B
- IOM, Publication 100-04, MCPM, Chapter 12, Section 30.5
- IOM, Publication 100-04, MCPM, Chapter 17
Education
Documentation Supporting Infusion Units Billed
Per guidelines found in the Current Procedural Terminology (CPT®) manual, when reporting codes for which infusion time is a factor, use the actual time over which the infusion is administered. The CPT® manual includes descriptors and guidelines when billing codes for hydration, chemotherapy, infusion, or injections. In order to evaluate the actual time of a hydration or infusion/injection services, it is important that the medical record include either documentation of the total infusion time or the start time and stop time of the infusion to support the services billed.
Therapeutic Administration Billing
Per the Current Procedural Terminology (CPT®) manual, therapeutic infusions should be billed for infusions lasting 16 minutes up to one hour with CPT® 96365. Report 96366 for infusion intervals of greater than 30 minutes beyond 1-hour increments. CPT® 96374 should be billed for an intravenous push, single or initial substance/drug, infusions for durations of 15 minutes or less.
