Reason Code 97 | Remark Codes M80 - JA DME
Reason Code 97 | Remark Codes M80
| Code | Description |
|---|---|
| Reason Code: 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. |
| Remark Codes: M80 | Not covered when performed when billed during the same session/date and a previously processed service for the patient. |
Common Reasons for Denial
- HCPCS billed is included in payment/allowance for another service/procedure that was already adjudicated
Next Step
- Review claim submitted for similar items provided on same date of service listed in Local Coverage Determination (LCD), LCD Policy Article and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need
- A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal
How to Avoid Future Denials
- Refer to applicable Local Coverage Determination (LCD), LCD Policy Article to determine whether the HCPCS code is included in another service or possibly bundled
- Payment for both oxygen contents used with stationary oxygen equipment and oxygen contents used with portable oxygen equipment is included in the 36 monthly payments for oxygen equipment HCPCS E0424, E0439, E1390, or E1391. Before submitting claim for contents, verify stationary or portable oxygen equipment has met all 36 rental month payments
Last Updated Dec 09 , 2023
