CGS Administrators, the Jurisdictions B and C Medicare DME MAC contractor, has released the results for Targeted Probe and Educate (TPE) reviews that took place October through December 2025 in 16 durable medical equipment (DME) categories.
While the Centers for Medicare & Medicaid Services says on its TPE webpage that most DME suppliers “will never need TPE,” the program “is intended to increase accuracy in very specific areas” and is used “to identify providers and suppliers who have high claim error rates or unusual billing practices, and items and services that have high national error rates and are a financial risk to Medicare.”
For the fourth quarter of 2025, CGS reported that 40% of suppliers who participated passed the 10-claim preview/pilot and did not proceed further. Of suppliers who proceeded, 71% passed round one and were excluded from the rest of the program. In round 2, 66.7% passed; in round 3, 81.8% passed.
CGS reported the highest error rates for surgical dressings (74.81%), lymphedema compression items (50.93%), pneumatic compression devices (42.29%), therapeutic shoes/inserts for patients with diabetes (41.98%), and knee orthoses (40.74%).
The lowest error rates were reported for immunosuppressive drugs (12.32%), oxygen and oxygen equipment (13.91%), continuous positive airway pressure (CPAP) and PAP supplies (15.92%), and hospital beds (18.13%).
CGS also conducted TPE reviews for ankle-foot orthoses (25.77% error rate), enteral nutrition (33.25%), glucose monitors and supplies (23.3%), manual wheelchairs (32.15%), nebulizers (36.75%), spinal orthoses (34.71%), and urological supplies (26.44%).
Suppliers chosen to participate in TPE are notified by the DME MAC, who reviews 20 to 40 claims and supporting documentation. If a supplier is found to be compliant, “You will not be reviewed again for at least one year on the selected topic” unless the MAC notices “significant changes in provider billing.” Both CGS and Noridian Healthcare Solutions, the Jurisdictions A and D MAC contractor for DME, also perform 10-claim “previews” before starting the full round one review of 20 to 40 claims. Suppliers whose 10-claim previews are found to be compliant exit the TPE program at that point. Suppliers who do not pass the preview enter round one of TPE.
If the MAC denies some of the 20 to 40 claims it reviewed, “You will be invited to a one-on-one education session,” CGS said. The supplier is given at least 45 days to implement changes and improve processes, after which time the MAC reviews another set of claims and supporting medical records. Suppliers can go through the cycle up to three times. Those who do not improve after three rounds “will be referred to CMS for next steps” that could include 100% prepayment review.
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