Nearly one out of every three Targeted Probe and Educate (TPE) denials in the second quarter of 2026 were attributed to “skilled nursing not medically necessary,” according to a quarterly report by CGS Medicare, a Medicare Administrative Contractor serving 15 states and Washington, D.C.
- Skilled nursing not medically necessary: 32.2%
- Initial certification invalid: 17.1%
- Therapy visits not medically necessary: 14.7%
- Face-to-face documentation is missing, incomplete, or untimely: 13.7%
- No Plan of Care/certification: 5.2%