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 codes: 93307, 93320, 93325
Resolution/Resources
- Jurisdiction 1: Refer to the 'Echocardiography, Transthoracic and Transesophageal - Revised' Local Coverage Determination and Coverage Article on the Palmetto GBA Web site:
- Ohio, South Carolina, West Virginia: Refer to the 'Transthoracic Echocardiography' Local Coverage Determination and Coverage Article on the Palmetto GBA Web site:
- Ohio: www.PalmettoGBA.com/boh/LCD
- South Carolina: www.PalmettoGBA.com/bsc/LCD
- West Virginia: www.PalmettoGBA.com/bwv/LCD
- LCD Reconsideration Process: To request changes to any existing LCD, fax clinical evidence/documentation to Palmetto GBA
- If the service being performed is not covered under the LCD guidelines, we encourage you to provide your patients with an Advance Beneficiary Notice (ABN) prior to performing these tests
Advance Beneficiary Notice Information
- 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 a copy 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 our 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.
- 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: