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Outpatient Occupational and Physical Therapy Services Billing Guide
- Introduction to Outpatient OT and PT Services
- Outpatient Occupational and Physical Therapy Coverage
- Caregiver Training Services
- KX Modifier Threshold
- 2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring
- Annual Update to the Therapy Code List
- Targeted Medical Review
- Functional Reporting - Using the G Codes
- What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy
- Maintenance Programs
- Multiple Procedure Payment Reduction
- The National Correct Coding Initiative
- Comprehensive Error Rate Testing Program
- Recovery Auditor
- Common Billing Errors and Remittance Message
- Medical Review Therapy Documentation Checklist for Additional Development Request Letters
- Common Questions and Answers
- Related Content
- Related Articles
Common Billing Errors and Remittance Message
Remittance Remark Code Listing: X12
Message | Narrative |
---|---|
119 | Benefit maximum for this time period or occurrence has been met. |
18 | Duplicate claim/service. |
109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. |
B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 REF Segment: Healthcare Policy Identification, if present. |
29 | The time limit for filing has expired. |
97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
22 | This care may be covered by another payer per coordination of benefits. |
50 | This decision was based on a LCD. An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD. |
18 | Exact duplicate claim/service |
150 | This service/equipment/drug is not covered under the patient’s current benefit plan. |
119 | Benefit maximum for this time period or occurrence has been reached. |
31 | Patient cannot be identified as our insured. |
21 | This illness/injury is the liability of the no-fault carrier. |
22 | This care may be covered by another payer per coordination of benefits. |
16 | Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
185 | This provider type/provider specialty may not bill this service. |
Reviewed 10/07/2024