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MR Activity Log 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.

Home Health
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

Hospice
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

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