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LDL Cholesterol: 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: 83721
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, which is 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/
- As of July 31, 2007, CPT code 83721 is bundled with the following CPT codes with indicator '1': 80061, 82465. If 83721 is a separate, distinct service, submit CPT modifier 91. Examples of separate, distinct services include situations in which the LDL cholesterol test was performed at a different patient encounter from the procedure with which it was bundled. Supporting documentation is required in the medical records.
- As of 7/31/07, CPT code 83721 is bundled with the following CPT code with indicator '0' and cannot be reimbursed separately under any circumstances: 83700, 83701, 83704, 83715, and 83716
- CPT codes 80500 and 80502 are bundled with 83721 with indicator '1'
- For specific information on modifiers that may be used to denote exceptions to CCI (including CPT modifier 91), refer to the Palmetto GBA Modifier Lookup tool: