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Last Modified: 4/18/2020 Location: FL, PR, USVI Business: Part A

Avoiding reason code 76474 FAQ

Q: We are receiving reject reason code 76474, so what steps can we take to avoid this reason code?
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: You are receiving this reason code when the patient has met the Medicare annual therapy cap limit for the calendar year.
Confirm the beneficiary’s physical and occupational therapy cap information via the following:
Main menu select option for Eligibility, then select option 3 for physical and occupational therapy information.
or
Secure Provider Online tool (the SPOT) the ‘Eligibility/Benefits Inquiry’ page, if the required beneficiary information is entered, the ‘Benefits/Eligibility’ submenu will be visible and more beneficiary information/history will be accessible for example ‘Deductibles/Caps’ with the following:
Beneficiary’s occupational therapy information:
Calendar year -- the calendar year associated with the used dollar amount that has been applied to the capitation limit for occupational therapy services.
Used amount -- the used dollar amount that has been applied to the capitation limit for occupational therapy services for the calendar year indicated.
Beneficiary’s physical and speech therapy information:
Calendar year -- the calendar year associated with the used dollar amount that has been applied to the capitation limit for physical and speech therapy services.
Used amount -- the used dollar amount that has been applied to the capitation limit for physical and speech therapy services for the calendar year indicated.
Refer to the ‘Rehabilitation Services’ specialty page designed specifically for rehabilitation service providers.
For information on how to submit your claim properly refer to
Centers for Medicare & Medicaid Services (CMS) internet-only manuals (IOM),
Publication 100-04, Medicare Claims Processing manuals,
Chapter 5 Part B Outpatient Rehabilitation and CORF/OPT Services external link
list item Please use your browser's back button to return to the referring page.
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.