Home Health and Hospice Medical Review Activity Log
The primary focus of Targeted Probe and Educate (TPE) reviews is to determine if medical record documentation supports Medicare medical necessity guidelines for the services billed.
| Review Topic | Edit Numbers | Description | Review Type | Status |
|---|---|---|---|---|
| Medical necessity | 5A007 5B007 5C007 5G007 |
Claims with 2-6 visits and diagnosis code I11.0, Z46.6, J44.0, J44.1, J44.81, J44.89, J44.9, I10, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, I25.10, N39.0, J18.9, or I87.2 | TPE prepayment review | Active |
| New providers | 5A006 5B006 5C006 5G006 |
Claims for new providers with at least 50 claim submissions | TPE prepayment review | Active |
| Medical necessity | 5N000 5T000 5V000 5G000 |
Claims with 2-6 visits and diagnosis code I11.0, Z46.6, J44.0, J44.1, J44.81, J44.89, J44.9, I10, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, I25.10, N39.0, J18.9, or I87.2 | TPE Round 1 (postpayment) Round 2 (prepayment) Round 3 (prepayment) |
Active |
| Review Topic | Edit Numbers | Description | Review Type | Status |
|---|---|---|---|---|
| LOS with non-oncologic diagnosis | 5D000 5E000 5F000 5J000 |
Claims with length of stay (LOS) >730 days and non-oncologic diagnosis code | TPE prepayment review | Active |
| General inpatient (GIP) level of care (LOC) | 5D006 5E006 5F006 5J006 |
Claims with revenue code 0656 (7 days or more) | TPE prepayment review | Active |
| New providers | 5D008 5E008 5F008 5J008 |
Claims for new providers with at least 50 claim submissions | TPE prepayment review | Active |
| LOS 313-515 days | 5D010 5E010 5F010 5J010 |
Claims with length of stay (LOS) 313-515 days | TPE prepayment review | Active |
Updated: 07.30.2026

