Reason Code 7Z167 - JF Part A
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
View reason code list, return to Reason Code Guidance page.
Last Updated Mon, 18 Jun 2018 14:35:59 +0000