Last Modified: 6/28/2018 Location: FL, PR, USVI Business: Part A
Reject reason code 36428 FAQ
Q: What steps can we take to avoid reject reason code 36428?
Click here for a description associated with the Medicare Part A reason code(s). Simply enter a valid reason code into the box and click the submit button.
A: A claim for mammography screening services has been submitted, and either the Food & Drug Administration (FDA) certification records need to be updated or the mammography services are outside the scope of the FDA certificate on file.
There are two types of mammography services:
1. Computer aided detection/film
Refer to the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN) Preventive Services resource for coding and billing information.
Ensure your FDA certification is for the "type" of mammography service you're providing and that the service is within the dates covered by the certificate.
• If your certification has expired, it must be updated prior to providing and billing mammography services
• Certification information may be updated with First Coast via mail or fax:
P.O. Box 2078
Jacksonville, FL 32231-2078
Please allow at least seven business days for certification data to be updated.
• Submit claim adjustments for all claims that rejected with reason code 36428
• Click here for guidance on when to adjust a rejected claim
Source: CMS internet-only manual (IOM), publication 100-04, Chapter 18 preventive and screening services
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Source: First Coast's Education Action Team
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