The Palmetto GBA Denial Finder tool includes resources for resolving the top claim rejections and denial reasons. Save time and resources by looking here before you pick up the phone.
- Access denial reasons in plain language
- Scroll through the titles to locate your procedure
- Use the Palmetto GBA search engine to search by remark code
Following are five of the top reasons that services submitted to Palmetto GBA are denied:
- Noncovered services by a chiropractor – the only service Medicare will reimburse, when performed by a chiropractor, is manual manipulation of the spine (CPT codes 98940, 98941, and 98942). Physical therapy and x-rays performed by chiropractors are never covered by Medicare.
- 'Noncovered services' – these services are never covered, including eye refraction, 'well person' exams, and hot/cold packs used in physical therapy
- Bundling due to 'Correct Coding Initiative' – services denied most often for these reasons include: pulse oximetry, heparin, creatinine (blood) and some supplies
- Medicare is secondary, but the claim was submitted as primary. The MSP Lookup Tool can help guide you as to whether another insurer may be involved.
- Pre- and post-op visits are included in the global surgery package. Tip: access the CMS Medicare Physician Fee Schedule Database (MPFSDB) to determine the global period for surgical procedures. The Palmetto GBA Modifier Lookup tool provides step-by-step instructions for accessing the MPFSDB as well as guidance on how to submit 'exceptions' to the global surgery package.
Use the Denial Finder to determine whether your denials for these services are correct or whether there are other steps you should take before submitting these claims.