Reason Code 7Z167

Reason Code Narrative

Intensity-Modulated Radiation Therapy (IMRT) Not Allowed

Common Reason Code Errors

CPT 77386 is not allowed with diagnosis code C61, C50011-C50929, Z8546 or Z853, per CPT definition

  • "Simple: Any of the following: prostate, breast, and all sites using physical compensator based IMRT."
  • "Complex: Includes all other sites if not using physical compensator based IMRT."

Common Reason Code Corrections

  • Claim will be Returned to Provider (RTP)
  • Providers must remove history diagnosis code, if not treating for that particular disease; or
  • Providers must correct billed CPT 77386 to 77385
  • Do not submit a request for appeal or reopening as there are no appeal rights are afforded

Resource

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

 

Last Updated Mon, 18 Jun 2018 14:35:59 +0000