Reason Code 55500

Local Medical Review Policy (LMRP) or Local Coverage Determination (LCD) was used when we made this decision, an LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered by Medicare. A copy of this policy is available from your local intermediary or carrier by calling the number in the customer service information box on page one. You can compare the facts in your case to the guidelines set out in the LMRP/LCD to see whether additional information from your physician would change our decision.

Common Reason Code Corrections

  • These claims will have a LMRP, LCD, or Local Coverage Article (LCA) associated with the denied line
    • Review the policy
    • Is all Medicare Coverage criteria met and supported in the submitted documentation?
  • A Redetermination request may be submitted if facility feels that sending additional documentation will support need for service(s) provided
    • Redetermination should include:
      • All applicable supporting medical documentation
      • Corrected UB-04 form
    Direct Data Entry (DDE) users can view the remarks section for additional clarification.

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Last Updated Thu, 15 Sep 2022 16:47:52 +0000