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First Coast Service Options Inc.
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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
(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 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.
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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.