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Established Patient Office Visits: CCI Bundling Denials
Denial Reason, Reason/Remark Code(s)
- M-80: Not covered when performed during the same session/date as a previously processed service for the patient
- CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
- CPT code: 99211
Correct Coding Initiative: The Correct Coding Initiative (CCI) packages, or 'bundles,' reimbursement for some services under Medicare. CCI identifies code pairs that are never reimbursed separately and code pairs that can only be reimbursed separately in certain circumstances (identified by the appropriate modifier).
Resources
- Check CCI edits prior to claim submission; edits are updated quarterly. CCI edits are available at: www.cms.hhs.gov/NationalCorrectCodInitEd/
- CPT code 99211 is bundled with many CPT codes
- If CPT code 99211 is marked with indicator '0' in the CCI edit list, it cannot be reimbursed separately from other procedures. Do not submit the service.
- If CPT code 99211 is a separate, distinct service and is marked with indicator '1' in the CCI edit list, submit CPT modifier 25 to denote it as a separate service
- Examples of separate, distinct services include situations in which the minimal office visit was performed a different patient encounter from the procedure with which it is bundled. Supporting documentation is required in the medical records.
- For additional, specific information on modifiers that may be used to denote exceptions to CCI (including CPT modifier 25), refer to the Palmetto GBA Modifier Lookup tool: