Last Modified: 1/22/2014 Location: FL, PR, USVI Business: Part B
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Resources/tips for avoiding this denial
Denial indicates service billed has been paid as part of another service/procedure billed for the same date of service.
Payment for this service is always bundled into payment for other service(s) not specified. The Centers for Medicare & Medicaid Services (CMS) has assigned relative value units (RVUs) for many of the bundled services; however, the RVUs are not for Medicare payment use. Separate payment is never made. When this service is covered, payment is included in payment for the service to which it is incident. (An example of a “bundled service” is a telephone call from a hospital nurse regarding a patient. Another example is procedure code A4550, surgical tray.)
• Check the procedure code on the First Coast fee schedule lookup tool. Click on “more” under modifier. If status of code is equal to “b,” the service/procedure is not paid separately, not even by appending a modifier.
• See the CMS Internet-only manual (IOM), publication 100-04, chapter 12, section 20.3 for additional details.
Source: FCSO Education Action Team