Last Modified: 2/5/2010
Location: FL, PR, USVI
Business: Part A
This is a claim level reject reason code for claims that have all line items rejected by V8022, V8024, U5412, or U5413 from common working file (CWF).
Tips
Review the claim and the individual reason codes received on the line items to correct therapy expense and resubmit the claim. The individual reason codes listed for 10417 describe the following:
• V8022 -- outpatient physical therapy expense limit is over applied. Physical therapy expense submitted is greater than the expense to be met.
• V8024 -- occupational therapy expense submitted is greater than the expense to be met.
• U5412 -- physical therapy adjustment is necessary for Medicare secondary payer (MSP) claim. This edit will be bypassed for all choices, end-stage renal disease (ESRD) managed care demo and encounter claims.
• U5413 -- occupational therapy adjustment is necessary for MSP claim. This edit will be bypassed for all choices, ESRD managed care demo, and encounter claims.
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Source: FCSO Education Action Team
