Last Modified: 8/27/2020
Location: FL, PR, USVI
Business: Part B
Q: We received a denial with claim adjustment reason code (CARC) PR 49. What steps can we take to avoid this denial?
This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
A: The denial was received, because the service is a routine/preventive exam or diagnostic/screening procedure done in conjunction with a routine/preventative exam. Diagnostic/screening procedures and evaluation and management (E/M) services for routine or screening purposes, such as an annual physical, are not covered by Medicare.
cover certain preventive services, including an Initial Preventive Physical Examination (IPPE) and an Annual Wellness Visit (AWV). Click here
for information on covered preventive services, including coding and billing.
If an error was made, make the necessary correction, and resubmit your claim.
• If a payable diagnosis is indicated in the patient's medical record, correct the diagnosis, and resubmit the claim.
• If a covered preventive service was coded incorrectly, correct the code, and resubmit the claim.
• Prevent a duplicate denial: Submit corrected line item(s) only.
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