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 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

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

 

Last Updated May 22, 2018