TPE Results
December 2025 - May 2026
Based on data analysis, Medical Review initiated complex review edits for specific providers that demonstrated a high risk for improper payment. CGS offered targeted education to providers during, and upon completion of, each round of review.
The information below describes Targeted Probe and Educate (TPE) results for Part B providers.
Probes Completed
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 1 | 7 |
| Providers compliant after round 1 completion | 0 | 1 |
| Providers moving to round 2 | 1 | 5 |
| Providers compliant after round 2 completion | 0 | 1 |
| Providers with non-response to ADRs | 1 | 0 |

Top Findings
- The documentation submitted lacked elements that support medical necessity for the drug or biological administration.
- Failure to provide supporting documentation for a dosage above FDA guidelines.
- Incorrect modifier usage.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 0 | 3 |
| Providers moving to round 2 | 0 | 1 |
| Providers compliant after round 2 completion | 0 | 1 |
| Providers moving to round 3 | 0 | 1 |

Top Findings
- Missing documentation such as physician order, signed certification, progress notes.
- Documentation doesn't support medical necessity for visits exceeding the recommended amount.
- Incorrect modifier usage.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 7 | 16 |
| Providers compliant after round 1 completion | 1 | 3 |
| Providers moving to round 2 | 3 | 7 |
| Providers compliant after round 2 completion | 1 | 3 |
| Providers compliant after round 3 completion | 1 | 0 |
| Providers moving to round 3 | 1 | 2 |
| Providers referred to CMS after round 3 completion | 0 | 1 |
| Providers with non-response to ADRs | 1 | 3 |

Top Findings
- Missing documentation such as physician order, signed certification, progress notes.
- Documentation doesn't support medical necessity for visits exceeding the recommended amount.
- Incorrect modifier usage.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 5 | 3 |
| Providers compliant after round 1 completion | 3 | 3 |
| Providers moving to round 2 | 2 | 0 |
| Providers with non-response to ADRs | 2 | 0 |

Top Findings
- Missing documentation to support medical necessity, including visual acuity requirements.
- Non-response to ADRs.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 4 | 4 |
| Providers compliant after round 1 completion | 0 | 0 |
| Providers moving to round 2 | 2 | 2 |
| Providers moving to round 3 | 2 | 1 |
| Providers referred to CMS after round 3 completion | 0 | 1 |
| Providers with non-response to ADRs | 1 | 1 |

Top Findings
- Missing documentation to support medical necessity, including orders or documentation to support the need for CT.
- Non-response to ADRs.
- The documentation submitted doesn't support medical necessity for CT.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 4 | 5 |
| Providers compliant after round 1 completion | 1 | 2 |
| Providers moving to round 2 | 2 | 2 |
| Provider compliant after round 2 completion | 1 | 1 |
| Providers with non-response to ADRs | 1 | 2 |

Top Findings
- Documentation doesn't support the level of service billed.
- Non-response to ADRs.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 17 | 6 |
| Providers compliant after round 1 completion | 2 | 0 |
| Providers moving to round 2 | 11 | 3 |
| Providers compliant after round 2 completion | 0 | 0 |
| Providers moving to round 3 | 3 | 3 |
| Providers compliant after round 3 completion | 1 | 0 |
| Providers referred to CMS after round 3 completion | 1 | 0 |
| Providers with non-response to ADRs for round 1 | 0 | 3 |

Top Findings
- Documentation doesn't support the specific reason for the test.
- Documentation doesn't support the testing frequency.
- Documentation is missing elements such as lab results, order, or documentation to support medical necessity.
- Non-response to ADRs.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 0 | 4 |
| Providers compliant after round 2 completion | 0 | 4 |
| Providers with non-response to ADRs for round 1 | 0 | 2 |

Top Findings
- Documentation doesn't support medical necessity due to lack of specific and precise physical findings and assessments.
- Non-response to ADRs.
| Results | Kentucky | Ohio |
|---|---|---|
| Probes completed | 2 | 15 |
| Providers compliant after round 1 completion | 1 | 4 |
| Providers moving to round 2 | 1 | 7 |
| Providers compliant after round 2 completion | 0 | 1 |
| Providers moving to round 3 | 0 | 1 |
| Providers compliant after round 3 completion | 0 | 1 |
| Providers referred to CMS after round 3 completion | 0 | 1 |
| Providers with non-response to ADRs | 0 | 5 |

Top Findings
- Missing documentation to support medical necessity such as conservative measures, diagnostic imaging report, or notification to primary care provider of continuation of steroid use.
- Documentation doesn't support medical necessity.
- Non-response to ADRs.
Education
Provider education sessions are available via webinar or traditional teleconference:
- Individualized education sessions after each round of review.
- Intra-probe education sessions for providers with high curable errors.
- Widespread Level II webinars that include TPE data, a high-level policy overview, and documentation examples.
CGS also publishes relevant website articles:
- TPE & Appeals Processes
- Claim Resubmission/Rebilling
- Billing Instructions for Concurrent Care E&M Service: Similar Services from Multiple Physicians & NPPs Within the Same Group
- Billing Professional & Technical Components
Please email questions or education requests to J15BProbeandEducation@cgsadmin.com.
Next Steps
At the completion of TPE round 1/2, providers identified as non-compliant will advance to TPE round 2/3 at least 45 days from the 1:1 post-probe education call completion date. You may request education at any time even if you aren t selected for TPE. CGS encourages providers to request education, conduct self-monitoring based on posted MR Activities, and use other self-service tools available on our website.
References
- CMS Medicare Program Integrity Manual (Pub. 100-08), Chapter 3

- MR Activities
- Targeted Probe and Educate (TPE)
- Targeted Probe and Educate | CMS

Updated: 06.23.2026
Reviewed: 06.23.2026

