On August 17, 2020, medical review activity resumed as directed by CMS, with implementation of post-payment service specific medical record review. For additional information please see Medicare Learning Network (MLN) Connects newsletter.
The following table lists and summarizes the historical post-payment service specific medical record review activity and results for Medical Review Part B. All reviews have been completed at this time. For additional information on current Medical Review activities please visit our Current Targeted Probe and Educate (TPE) activities page.
Service specific review topic |
Service specific results |
End stage renal disease (ESRD) services (CPT 90960-90962) |
ESRD results |
Drugs and biologicals: Drug injections (HCPCS J0178 (Eylea), J2778 (Lucentis) with associated administration code (CPT 67028) |
Drug injection results |
Surgical services: Cataract extraction (CPT 66982-66984) |
Cataract extraction results |
Rehabilitation services: Outpatient physical and occupational therapy (CPT 97010-97546) |
Therapy results |
Psychiatric services: Psychotherapy (CPT 90832, 90834, 90837) |
Psychotherapy results |
Laboratory services: Definitive drug testing (HCPCS G0480-G0483) |
Laboratory results |
Ambulance services: Emergency advanced life support (ALS-1) Transport (HCPCS A0427, A0425) |
Ambulance results |
Paravertebral facet joint injections (CPT 64490-64492) |
Facet joint injection results |
Nail cutting/paring and debridement (CPT 11719-11721, 11055-11057; HCPCS G0127) |
Foot care results |
Trigger point injection (CPT 20552, 20553) |
Trigger point injection results |
Drugs and biologicals: Drug injections (HCPCS J1745) Remicade with associated administration code(s) |
Drug injection results |
Other diagnostic tests: Neurological testing (CPT 92585, 95816, 95930, 95957) |
Neuro testing results |
Rehabilitation services: Outpatient physical, occupational and speech therapy (CPT 97010-97546) billed with KX modifier |
Therapy KX results |
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