Last Modified: 12/10/2010
Location: FL, PR, USVI
Business: Part B
PR 96
Non-covered charge(s)
(THE PROCEDURE CODE SUBMITTED IS A NON-COVERED MEDICARE SERVICE)
Resources/tips for avoiding this denial
There are multiple resources available to verify if services are covered by Medicare:
• The FCSO Medicare provider Web site has links addressing local medical coverage. Specific codes and data can be found within “Active/Future/Retired LCDs”, including indications and limitations of coverage or medical necessity.
Resources available through the First Coast Service Options (FCSO) Medicare training Web site (www.fcsomedicaretraining.com)
:
• Several free Web-based training (WBT) courses exist, which may assist you with understanding Medicare's guidelines and regulations. Click here for a list of available courses.
Tips to correct the denied claim
This denial is not usually able to be corrected.
• If you are submitting non-covered services to receive a denial for secondary or supplemental insurance, ensure to bill services with the modifier GY, indicating "statutorily non-covered services."
Source: FCSO Education Action Team