Denial Reason, Reason/Remark Code(s)
- CO-50, CO-57, CO-151, N-115 - Medical Necessity: An ICD-9 code(s) was submitted that is not covered under a LCD/NCD
- CPT code: 83880
Resolution/Resources
- Refer to the 'Brain Natriuretic Peptide (BNP)' Local Coverage Determination and Coverage article on the Palmetto GBA Web site:
Advance Beneficiary Notice (ABN) Information
- If the service being performed is not covered under the LCD guidelines, we encourage you to provide your patients with an 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 the 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 Modifier Lookup tool on the Palmetto GBA Web site for information on HCPCS modifier GA:
last updated on 12/29/2009