skip to content Site Map
First Coast Service Options Inc.
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the J9 provider community.
If you are a Medicare beneficiary please visit
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select your location:
Select one:
Join eNews Site Map Tools Center Contact Us New Visitor Center
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Email | Print |
Last Modified: 3/30/2014 Location: FL, PR, USVI Business: Part B

PR 49

These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam
Resources/tips for avoiding this denial
Denial indicates the procedure code and/or evaluation and management (E/M) service was billed with a screening diagnosis.
Note: Medicare does not cover diagnostic/screening procedures or E/M services for routine or screening purposes, such as an annual physical. This denial would be appropriate in this case.
Before submitting a claim, you may access the Procedure to diagnosis relationship lookup tool, to help determine if the procedure code to be billed is payable under the specific diagnosis.
Refer to the "Active/Future/Retired LCDs" medical coverage policies for a list of procedure codes relating to services addressed in the local coverage determination (LCD), and the diagnoses for which a service is/is not considered medically reasonable and necessary.
Medicare does cover certain preventive services, which may often be coded inappropriately.
Click here for more information on covered preventive services.
Click here external pdf file for information on coding and billing for the Initial Preventive Physical Examination (IPPE) and the Annual Wellness Visit (AWV), both covered preventive benefits.
Tips to correct the denied claim
If a payable diagnosis is indicated in the patient's encounter/service notes or record, correct the diagnosis and resubmit the claim.
Do not resubmit an entire claim when a partial payment has been made; correct and resubmit denied lines only.
If a covered preventive service was not coded properly, correct the code and submit the corrected claim.
list item Please use your browser's back button to return to the referring page.
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.