Reason Code 7THER

Reason Code Narrative

THERAPY CAP - PROVIDER LIABLE

Common Reason Code Errors

Therapy services billed exceed the pre-determined therapy cap.

Common Reason Code Corrections

  • If the therapy service is justifiable a Redetermination request should be submitted.
    • Redetermination should include:
      • All applicable supporting medical documentation
      • Corrected UB-04 form
      • If excessive units were submitted in error, a Redetermination can be submitted.

Redeterminations will only review medically denied lines.

Resource

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Last Updated Wed, 26 Feb 2020 15:24:20 +0000