Reason Code W7009

Reason Code Narrative

NON-COVERED UNDER ANY MEDICARE OUTPATIENT
BENEFIT, FOR REASONS OTHER THAN STATUTORY EXCLUSION

Common Reason Code Errors

  • Service(s) that Medicare does not cover were submitted on the claim

Common Reason Code Corrections

  • Verify coverage determinations in Internet Only Manual (IOM), National Coverage Determinations(NCDs), Local Coverage Determinations (LCDs), CPT and HCPC descriptions
  • A Redetermination may be submitted if the facility feels that sending additional documentation will support the 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.

Resources

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

 

Last Updated Fri, 28 Feb 2020 12:39:28 +0000