Targeted Probe and Educate (TPE) Medical Review Results - JE Part B
Targeted Probe and Educate (TPE) Medical Review Results
The Jurisdiction E, Part B Medical Review Department has identified the following top trending errors through ongoing claim review activities from July 1, 2026 through September 30, 2026. These findings are shared to promote provider awareness and support compliance with Medicare coverage, coding, and documentation requirements. Addressing these common findings may help reduce claim denials, improve claim submission accuracy, and promote appropriate payment of covered services.
Diagnostic Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Documentation submitted does not support medical necessity as listed in the National Coverage Determination or Local Coverage Determination |
| 2 | Documentation submitted was not complete or insufficient |
| 3 | Records that were requested were not received |
Service(s) Related to Top Errors
CPT® Codes: 71045, 71270, 72148, 74177, 75571, 76700, 76856, 78608, 86003, 88305, 93351, 93925, 95816
Educational Resources
- CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3
- Social Security Act (SSA), Title 18, 1862
- Medical Review (MR) Documentation Requirements
End-Stage Renal Disease (ESRD) Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Records that were requested were not received |
| 2 | Documentation submitted was for the incorrect date of service |
| 3 | Documentation submitted was not complete or insufficient |
Service(s) Related to Top Errors
CPT® Codes: 90960, 90961, 90962
Educational Resources
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 11
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 8, Section 140
- End Stage Renal Disease (ESRD) / Dialysis Documentation Requirements
E&M Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Records that were requested were not received |
| 2 | Documentation submitted did not support medical necessity of the level of service billed |
| 3 | Documentation submitted was not complete or insufficient |
Service(s) Related to Top Errors
- CPT® Codes: 99203, 99212, 99213, 99214, 99215, 99291, 99292, 99308, 99309, 99310, 99458
- HCPCS Code: G2211
Educational Resources
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 13, Section 230, 230.2, 230.2.1
- CMS Medicare Learning Network (MLN) Booklet 909188 – Chronic Care Management Services
- Chronic Care Management (CCM) Frequently Asked Questions
- Evaluation and Management Documentation Requirements
Drugs and Biological Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Documentation submitted does not support medical necessity as listed in the National Coverage Determination or Local Coverage Determination |
| 2 | Documentation submitted does not support medical necessity for the number of services or items within the timeframe |
| 3 | Documentation submitted does not support the number of units billed |
Service(s) Related to Top Errors
HCPCS Codes: J0585
Educational Resources
- Billing and Coding Article: JW and JZ Modifier Billing Guidelines (A53024)
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 230.2B
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 17
- Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently Asked Questions
- Drug Administration Documentation Requirements
Nerve Injection Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Records that were requested were not received |
Service(s) Related to Top Errors
CPT® Codes: 62322
Educational Resources
- Billing and Coding Article: Epidural Steroid Injections for Pain Management (A58993)
- Local Coverage Determination (LCD): Epidural Steroid Injections for Pain Management (L39240)
Psychiatric Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Records that were requested were not received |
| 2 | Documentation submitted does not support medical necessity |
| 3 | Documentation submitted was not complete or insufficient |
Service(s) Related to Top Errors
CPT® Codes: 90833, 90837, 96130
Educational Resources
- Social Security Act (SSA), Title 18, 1862
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 12
- CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 3
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15
- Mental Health Documentation Requirements
Surgical Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Documentation submitted does not support medical necessity as listed in the National Coverage Determination or Local Coverage Determination |
| 2 | Documentation submitted did not support the service was performed as billed |
| 3 | Documentation submitted does not support modifiers billed |
Service(s) Related to Top Errors
CPT® Codes: 11055, 11056, 11057, 13132, 66174, 68761
Educational Resources
- CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 3
- Social Security Act (SSA), Title 18, 1862
- Surgery and Procedure Services Documentation Requirements
Outpatient Rehabilitation Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Documentation submitted does not support medical necessity as listed in coverage requirements |
| 2 | Records that were requested were not received |
| 3 | Documentation submitted did not include a progress report that was completed a minimum of every 10th treatment visit throughout the episode of care, or within 7 calendar days from the end date of the reporting period |
Service(s) Related to Top Errors
CPT® Codes: 97110, 97112, 97116, 97140, 97150, 97161, 97162, 97164, 97530, 97535
Educational Resources
Last Updated Oct 28 , 2026
