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 Jun 18, 2018