Reason Code 45 | Remark Codes N88

Code Description
Reason Code: 45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement
Remark Codes: N88 Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care

 

Common Reasons for Denial

  • Payment was made for this claim conditionally because an HHA episode of care has been filed for this patient.

Next Step

  • Payment may be recouped if it is established that the patient concurrently receives treatment under an HHA episode of care because of the consolidated billing requirements

How to Avoid Future Denials

  • Ensure eligibility is verified in the Noridian Medicare Portal for Home Health Episode History (HHEH)
  • Utilize the Consolidated Billing Tool on the Noridian Medicare website to inquire on items covered in a HHA episode of care, prior to providing

 

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