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Glucose Testing: Medical Necessity Denials
Denial Reason, Reason/Remark Code(s)
- CO-50, N-115 - Medical Necessity: An ICD-9 code(s) was submitted that is not covered under a LCD/NCD
- CPT codes: 82947, 82948, 82962
Resolution/Resources
- Refer to 'Blood Glucose Testing' National Coverage Determination (NCD) for information on covered conditions
- Blood Glucose Testing NCD: Locate Blood Glucose Testing by scrolling to bottom of page for 'Covered Code Lists (including narrative)'
- Information on how to make requests for NCD reconsiderations is available at www.cms.hhs.gov/DeterminationProcess
Advance Beneficiary Notice Information
- If the service being performed is not covered under the NCD guidelines, we encourage you to provide your patients with an Advance Beneficiary Notice (ABN) prior to performing these tests
- ABNs allow patients to make an informed decision about whether to receive a service that is likely to be non-covered on the basis of not reasonable and medically necessary
- If you utilize ABNs, they must be issued in advance. Maintain the original in the patient's medical record. Provide the patient with a copy of the signed notice.
- ABNs must be issued using the standard CMS form. For services provided on or after March 1, 2009, you must use the revised CMS ABN if you are providing advance notice to a beneficiary. Access the revised ABN and other background information from the CMS Web site at www.cms.hhs.gov/BNI/01_overview.asp.
- If you have obtained a valid ABN, submit claims for this service with HCPCS modifier GA. Refer to the Palmetto GBA Modifier Lookup tool for information on HCPCS modifier GA.