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Last Modified: 6/6/2014 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 Centers for Medicare & Medicaid Services (CMS) Web page that specifically addresses national medical coverage external link.
The First Coast Medicare provider website 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 First Coast University external link:
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."
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Source: First Coast Provider Outreach and Education

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.