11/19/2025

WPS Recent Oncology Related News

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WPS PART B ONLY

Medicare Part B Quarterly Average Sales Price (ASP) Pricing Files  HERE
Effective January 1, 2026

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8 Part B Targeted Probe and Educate Problem Error Rates

MACs conduct Targeted Probe and Educate (TPE) reviews to decrease provider burden, reduce appeals, and improve the medical review and education process. To avoid errors, providers should be aware of problem error rates and top reasons for denial.

Current Problem Error Rates for J8 Part B

Service Error Rate Intravitreal Injection CPT 67028 with 99211-99215 with modifier 25 79% Group Psychotherapy – 90853 68% Presumptive Drug Test – 80307 56% Wound Care Services – CPT 11042 42% Referring Provider TPE for 99214 35% Intravenous Infusion for Therapy, Prophylaxis, Diagnosis – CPT 96365 30% Percutaneous Implantation of Neurostimulator Electrode – 63650 22% Cataract Extraction – 66984 18%

Top Reasons for Denial for the Problems with the Three Highest Error Rates

Intravitreal Injection CPT 67028 with 99211-99215 with Modifier 25

·GBI02 - the documentation submitted supported the key elements or reasonable necessity of a lower level of service.

Group Psychotherapy – 90853

·GBB02 – the documentation submitted was incomplete or insufficient

·GBC01 – documentation submitted does not support medical necessity as listed in coverage requirements in the Local Coverage Determination

·GBI06 - the documentation submitted did not support incident-to criteria were met

Presumptive Drug Test – 80307

·GBC01 – documentation submitted does not support medical necessity as listed in coverage requirements in the Local Coverage Determination.

Closed Problems

In the second quarter of 2025, one Part B problem closed. The problem is listed below with the overall problem error rate.

Service Error Rate Drug Testing – G0483 40%

Additional information regarding each problem can be found in the Medical Review Guides and Resources section of our website.

Thanksgiving Holiday Closure

WPS will close on Thursday and Friday, November 27-28, 2025, in observance of Thanksgiving. We will re-open on Monday, December 1, 2025. If you need assistance, please contact us when we re-open.

Coming Soon: 2026 Physician Fee Schedules 

We will publish the 2026 Physician Fee Schedules (PFS) on our website as soon as possible after the CY 2026 physician fee schedule regulation is put on display. 

Once available, we will publish a news article with a direct link to the 2026 Physician Fee Schedules (PFS) webpage.