# | Proposed description | Notes |
1 | Documentation of unlisted or “by report” BR code was not received. Please resubmit your bill with the appropriate supporting documentation. | |
2 | Documentation of unlisted or "by report" BR code was not sufficiently documented in the attachments submitted. We are unable to make a payment without supplementary documentation giving a clearer description of the service. Please resubmit your bills with additional supporting documentation. | |
3 | The documentation does not support the level of service billed. Reimbursement was made for a code that is supported by the description of the service in documentation submitted with the billing. | |
4 | Reimbursement denied as this service requires prior authorization and none was identified. | |
5 | The charge for both the technical and professional component of this service have already been paid to another provider. | |
6 | Documentation indicating the amount of time or begin/end time for this service is required. Documentation was not submitted or did not include the time information. | |
7 | Missing/incomplete/insufficient requested documentation | |
8 | Reimbursement for physical therapy assessment or evaluation codes are denied. Provider is not eligible for reimbursement. | |
9 | Documentation supporting reimbursement for both test and measurements and evaluation and management or assessment and evaluation on the same day is required in accordance with jurisdictional guidelines | |
10 | Charge exceeds the maximum number of physical therapy modalities in a single visit. Reimbursement is made in accordance with the applicable fee schedule. | |
11 | Reimbursement denied for physical medicine extended time service. Charges billed without the "initial 30 minutes" base code. | |
12 | Charges for assessment and evaluation charge is denied. Services are reimbursable once within a 30 day period. The provider has billed for a physical therapy evaluation within the last 30 days. | |
13 | Reimbursement for physical medicine procedures, including Chiropractic Manipulation and acupuncture codes are denied. Charges exceed the maximum time allowed per visit without prior authorization. | |
14 | Reimbursement for physical medicine procedures, including Chiropractic Manipulation and Acupuncture codes are denied. Charges exceed the maximum number of modalities allowed per visit without prior authorization. | |
15 | Reimbursement denied based on jurisdictional guidelines regarding multiple services (cascade). | |
16 | Reimbursement based on jurisdictional guidelines regarding multiple services (cascade). | |
17 | Reimbursement for evaluation and management service in addition to physical medicine/acupuncture service provided during the same visit is made in accordance with the applicable fee schedule. | |
18 | Reimbursement denied. Documentation not submitted or does not support follow-up evaluation and management visit and physical medicine treatment in the same visit. | |
19 | Reimbursement denied. Provider is not eligible for reimbursement of evaluation and management services. | |
20 | Reimbursement of the initial casting service is included within the value of a fracture or dislocation reduction service. | |
21 | Reimbursement is denied. The visit or service billed, occurred within the global surgical period and is not separately reimbursable. | |
22 | Reimbursement for additional arthroscopic services were reduced in accordance with the applicable surgery guidelines. | |
23 | Reimbursement for the initial evaluation and management charge was reduced. Reimbursement is made using code 99025 in accordance with surgical guidelines. | |
24 | Reimbursement for assistant surgeon services are reduced in accordance with surgical guidelines | |
25 | Reimbursement for surgical assistant services are reduced in accordance with surgical guidelines. | |
26 | Reimbursement for assistant surgeon services are denied as not normally warranted for this procedure according to surgical guidelines | |
27 | Reimbursement for multiple surgeon services is not warranted for this procedure according to surgical guidelines. Please provide documentation that supports the need for multiple surgeons. | |
28 | Reimbursement for service is denied. Administration of local anesthetic is included in the surgical service in accordance with surgical guidelines. | |
29 | Reimbursement for anesthesia is reduced . Modifier -47 was used to indicate regional anesthesia administered by the surgeon. Time units are not reimbursed in accordance with surgery guidelines. | |
30 | Patient’s physical status/condition not identified. Please provide documentation using ASA Physical Status indicators. | |
31 | Reimbursement for evaluation and management service is denied. Documentation does not support a separate significant, identifiable service performed with other services provided on the same day. | |
32 | Reimbursement for services denied. The billed service does not meet the requirements of a consultation | |
33 | Reimbursement for services denied. Documentation provided does not support prolonged evaluation and management service. | |
34 | Reimbursement reduced. Reimbursement is based on a generic equivalent as “No Substitution” documentation was not provided. | |
35 | Reimbursement for dispensing fee is denied. Dispensing fee is not applicable for over-the-counter medication or medication administered at the time of a visit. | |
36 | Reimbursement for this item was based on the documented actual cost. | |
37 | Reimbursement for progress report charges are denied. Charges are reimbursable to the primary treating physician or his/her designee. | |
38 | The Permanent and Stationary Report charge was disallowed as you are not the Primary Treating Physician or his/her designee. | |
39 | Reimbursement for additional documentation is denied as duplicate documentation was not requested | |
40 | No payment is being made for missed appointment, as none is necessarily owed | |
41 | No reimbursement is being made as this procedure is not usually performed in an outpatient surgical facility. Prior authorization is required but was not submitted. | |
42 | Service not paid under outpatient facility fee schedule. | |
43 | This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation. The bill will be reimbursed using the regular reimbursement methodology. | |
44 | Missing Admission Summary | |
45 | Missing Prescription Order | |
46 | Missing Physician Order | |
47 | Missing Diagnostic Report | |
48 | Missing Discharge Summary | |
49 | Missing Nursing Notes | |
50 | Missing Support Data for Claim | |
51 | Missing Physical Therapy Notes | |
52 | Missing Report of Tests and Analysis Report | |
53 | Missing Doctor First Report of Injury | |
54 | Missing Supplemental Medical Report | |
55 | Missing Medical Permanent Impairment | |
56 | Missing Medical Legal Report | |
57 | Missing Vocational Report | |
58 | Missing Work Status Report | |
59 | Missing Consultation Report | |
60 | Missing Permanent Disability Report | |
61 | Missing Itemized Statement | |
62 | Medical necessity denial. You may submit a request for an appeal/reconsideration. | |
63 | Appeal/reconsideration denied based on medical necessity. | |
64 | Reimbursement is denied as there is a visit limitation on Physical Therapy, Chiropractic and Occupational Therapy encounters without prior authorization for additional visits. If you object contact the Utilization Review unit." | |
65 | According to the Fee Schedule this service has a relative value of zero and therefore no payment is due. | |
66 | Payment is denied as the service was provided outside the designated Network. | |
67 | The applicable fee schedule does not contain the billed code. An allowance has been made based on a comparable service. | |
68 | The applicable fee schedule does not contain the billed code. No payment is being made at this time. Please resubmit a bill with the appropriate fee schedule code(s) that best describe the service(s) provided and supporting documentation if required. |