Part A service-specific review -- hyperbaric oxygen therapy (G0277)

On August 17, 2020, medical review activity resumed, as directed by CMS, with implementation of post-payment service-specific medical record review.

First Coast is tasked with preventing inappropriate Medicare payments. One of the ways this is conducted is through medical review of claims. This helps to ensure that Medicare pays for services that are covered, coded correctly, and medically reasonable and necessary. 

High level results and top denial / partial denial reasons are listed below for the post-payment service specific reviews for hyperbaric oxygen therapy that have been conducted by First Coast. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. 

Hyperbaric oxygen therapy G0277 (December 2020) 

Top full / partial denial reasons:

The most common reasons for denial or partial denials are the following:

• Medical necessity – Documentation submitted did not support a covered condition or diagnosis based on policy to support the medical necessity of services billed.
• Insufficient documentation – Documentation submitted did not meet support the medical necessity of services billed
• Billing errors – Services were billed in error by provider.