5H164 - Documentation Does Not Support Medical Necessity

Published 05/22/2019

This claim was fully or partially denied because the documentation submitted for review does not support the medical necessity of some of the services billed.

To prevent this denial:

• Submit all documentation related to the services billed which support the medical necessity of the services
• A legible signature is required on all documentation necessary to support orders and medical necessity
• Use the most appropriate ICD-10-CM codes to identify the beneficiary’s medical diagnosis

For more information refer to: