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):