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Last Modified: 12/8/2009 Location: FL, PR, USVI Business: Part B

PR 96

Non-covered charge(s)

(THE PROCEDURE CODE SUBMITTED IS A NON-COVERED MEDICARE SERVICE)
Resources/tips for avoiding this denial
There are multiple resources available to verify if services are covered by Medicare:
• The CMS Web page that specifically addresses national medical coverage external link.
• The FCSO Medicare provider Web site has links addressing local medical coverage. Specific codes and data can be found within “Active/Future/Retired LCDs”, including indications and limitations of coverage or medical necessity.
Resources available through the First Coast Service Options (FCSO) Medicare training Web site (www.fcsomedicaretraining.com) external link:
• Several free Web-based training (WBT) courses exist, which may assist you with understanding Medicare's guidelines and regulations. Click here for a list of available courses.
Tips to correct the denied claim
This denial is not usually able to be corrected.
• If you are submitting non-covered services to receive a denial for secondary or supplemental insurance, ensure to bill services with the modifier GY, indicating "statutorily non-covered services."
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Source: FCSO Education Action Team