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: 82565
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/
- As of 1/1/2008, CPT code 82565 is bundled with CPT code 80047. CPT code 82565 is also bundled with the following CPT codes: 80048, 80053, 80069, and 82575.
- For these combinations of services, CPT code 82565 is designated with indicator '1' in the CCI edit list. If this is a separate, distinct service, submit CPT modifier 59 to denote it as a separate service.
Examples of separate, distinct services include tests that are performed different patient encounters. 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 59), refer to the Palmetto GBA Modifier Lookup tool: