Last Modified: 12/7/2009
Location: FL, PR, USVI
Business: Part B
(THIS PROCEDURE/ITEM NOT PAYABLE FOR THE DX AS REPORTED (LMRP))
Resources/tips for avoiding this denial
This denial indicates the procedure code billed is incompatible with the diagnosis.
• Refer also to “
Active/Future/Retired LCDs” for a list of procedure codes, relating to the services addressed in the local coverage determination (LCD), and diagnoses for which a service is/is not considered medically reasonable and necessary.
• Recording of a FCSO webcast on April 22, 2009:
Find LCDs and medical coverage information - Part A/B located in the "Library" of the
FCSO Medicare training Web site 
, under "Online resources."
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 partial payment is made; correct and resubmit denied lines only.
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Source: FCSO Education Action Team
before billing a claim to determine if the procedure code to be billed is payable under the specific diagnosis. 
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