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

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 Tue, 10 Nov 2020 18:35:08 +0000