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Last Modified: 12/10/2010
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
(ROUTINE EXAMINATIONS AND RELATED SERVICES NOT COVERED)
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 Lookup/Service Indication Report 
to determine if the procedure code to be billed is payable under the specific diagnosis.
to 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.
Resource available through the First Coast Service Options (FCSO) Medicare training Web site (www.fcsomedicaretraining.com) 
:
:• Recording of a FCSO webcast dated October 5, 2010 -- 10.05.10 - Avoid procedure-to-diagnosis claim denials - Part B FL, PR, USVI located under category "2010 FCSO Medicare Training webcasts" of the FCSO Medicare training Web site , under "Learning and Metrics."
, under "Learning and Metrics."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.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
