Use appropriate RA messages when processing claims. For denials effective January 1, 2007, use the following RA messages: Claim adjustment reason code 50: “These are non-covered services because this is not deemed a “medical necessity” by the...
Effective for dates of service on or after June 11, 2013, contractors shall use the following messages when denying claims in excess of three for PET FDG scans for subsequent treatment strategy when the KX modifier is not included, identified by Procedure codes...
Medicare Summary Notices, Remittance Advice Remark Codes, and Claim Adjustment Reason Codes Effective for dates of service on or after April 3, 2009, contractors shall return as unprocessable/return to provider claims that do not include the PI modifier with one...
Effective for dates of service on or after September 27, 2013, contractors shall return as unprocessable/return to provider claims for PET Aß imaging, through CED during a clinical trial, not containing the following: • Condition code 30, (A/B MAC (A) only) • Modifier...
When denying MRI line items on institutional claims when billed with the appropriate MRI code and modifier KX is not present, use the following messages: If ICD-9-CM is applicable, ICD-9 code V45.01 If ICD-10-CM is applicable, ICD-10 code Z95.0 • CARC 188 – This...
Denial Reason, Reason/Remark Code(s) • CO-50, CO-57, CO-151, N-115 – Medical Necessity: An ICD-9 code(s) was submitted that is not covered under a LCD/NCD • Procedure codes: 93307, 93320, 93325 Resolution/Resources...
Chest X-ray or EKG: Duplicate Denials Denial Reason, Reason/Remark Code(s) • M-80, CO-18 – Duplicate Service(s): Same service submitted for the same patient, same date of service by same doctor will be denied as a duplicate • ...
