Medicare review contractors (Medicare Administrative Contractors, Recovery Audit Contractors and the Supplemental Medical Review Contractor) develop and maintain lists of reasons for denying payment for Medicare covered services like hyperbaric oxygen therapy (HBOT). They have created denial reason codes with accompanying statements. A new set of Generic Reason codes and statements for Part A, Part B and DME have been made available by CMS that will be used for all Prior Authorization (PA), Claim reviews (including pre-pay and post-pay) and Pre-Claim reviews.
Here are the new “reason codes” for denial of HBOT (you can download the PDF file here):
NonEmergentHBO_ReasonCodesAndStatements_7.3.17
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
