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August 30, 2021 - Updated: 09.02.21

Resumption of the Targeted Probe and Educate (TPE) Medical Review (MR) Strategy - Revised

On August 12, 2021, CMS announced the restart of the Targeted Probe and Educate (TPE) program. TPE had been suspended since March 2020 due to the COVID-19 Public Health Emergency (PHE). Please note the following:

  • Post-payment reviews that are already in process will be completed. Continue to respond to all Additional Documentation Requests, including those for post-payment reviews.
  • All TPE cases that have remained open during the PHE are being closed.
  • The TPE review process may include up to three rounds of a prepayment claim review with education.
  • Suppliers selected for TPE will start at round 1, regardless of prior inclusion in the program.

Suppliers selected for TPE will receive a notification letter that outlines the TPE process and HCPCS codes that will be reviewed. For each claim selected for review, suppliers will receive an Additional Documentation Request (ADR) that includes a list of the specific documentation needed to support the HCPCS on review. (Do not submit documentation until it is requested; wait until you receive the ADR.)

We recommend signing up for DME myCGS to submit your responses directly within the portal. To get started, refer to the myCGS Registration and Account Management Guide.

Suppliers can email JB/JC TPE Inquiries with specific questions or concerns about the TPE program.

For additional information and resources, visit the Targeted Probe and Educate (TPE) Review Program page.

This article was revised on 09.02.21 to include the instruction: Post-payment reviews that are already in process will be completed. Continue to respond to all Additional Documentation Requests, including those for post-payment reviews.

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