Targeted Probe and Educate (TPE) Medical Review Results - JF Part B
Targeted Probe and Educate (TPE) Medical Review Results
The Jurisdiction F, 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 | Records that were requested were not received |
| 2 | Documentation submitted was not complete or insufficient |
| 3 | Documentation submitted does not support medical necessity as listed in the National Coverage Determination or Local Coverage Determination |
Service(s) Related to Top Errors
CPT® Codes: 70496, 71045, 71046, 73562, 74174, 74177, 74183, 78431, 80307, 88305, 88307, 88312, 88341, 92136, 92250, 93248, 93924, 93971
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 not complete or insufficient |
| 3 | Documentation submitted does not support services were performed as billed |
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 does not support medical necessity for the level of service that was billed |
| 3 | Documentation submitted was not complete or insufficient |
Service(s) Related to Top Errors
- CPT® Codes: 92014, 99203, 99204, 99212, 99213, 99214, 99215, 99222, 99223, 99231, 99232, 99233, 99239, 99285, 99291, 99306, 99308, 99309, 99310, 99347, 99348, 99349, 99350, 99439, 99487, 99490, 99497
- HCPCS Codes: G2211, G2212
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 | 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
HCPCS Codes: J0178, J0897, J2781, J2357, J3262, J7308, J7345, J9144
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
Hyperbaric Oxygen Therapy (HBOT)
| Top Errors | Top Error Details |
|---|---|
| 1 | Records that were requested were not received |
Educational Resources
- National Coverage Determination (NCD): Hyperbaric Oxygen Therapy (20.29)
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Section 30
- CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 3
- Hyperbaric Oxygen (HBO) Therapy Documentation Requirements
Nerve Injection Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Records that were requested were not received |
| 2 | Documentation submitted was not complete or insufficient |
| 3 | Documentation submitted does not support medical necessity as listed in the National Coverage Determination or Local Coverage Determination |
Service(s) Related to Top Errors
CPT® Codes: 64405, 64483
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 was not complete or insufficient |
| 3 | Documentation submitted does not support medical necessity |
Service(s) Related to Top Errors
CPT® Codes: 90833, 90834, 90836, 90837, 90838
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
Surgical Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Records that were requested were not received |
| 2 | Documentation submitted was not complete or insufficient |
| 3 | Documentation submitted does not support medical necessity as listed in the National Coverage Determination or Local Coverage Determination |
Service(s) Related to Top Errors
CPT® Codes: 11056, 17000, 17003, 17110, 20610, 20611, 27130, 66984, 93454, 93456, 93458, 96365, 97610
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 the coverage requirements |
| 2 | Documentation submitted does not support the initial plan of care was certified by the physician/NPP. No evidence of delayed certification or attempts to obtain certification from the physician/NPP |
| 3 | Documentation submitted did not include initial evaluation to support the therapy service(s) that were billed |
Service(s) Related to Top Errors
CPT® Codes: 97035, 97110, 97112, 97129, 97140, 97161, 97164, 97530, 97535
Educational Resources
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220-230
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 5, Section 10-20
- Outpatient Therapy Documentation Requirements
Therapeutic Radiation Services
| Top Errors | Top Error Details |
|---|---|
| 1 | Documentation submitted did not support service was performed as billed |
| 2 | Records that were requested were not received |
| 3 | Documentation submitted was not complete or insufficient |
Service(s) Related to Top Errors
- CPT® Codes: 77334, 77427, 77600
- HCPCS Code: Q4344
Educational Resources
Last Updated Oct 28 , 2026
