Reason Code 7THER - JE Part A

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. Request 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

• CMS Therapy Services

View reason code list, return to Reason Code Guidance page.