Reason Code 5H920: The Recommended Protocol Was Not Ordered and/or Followed
Reason for Denial
The physician’s orders submitted did not cover all of the units billed.
To Prevent This Denial
In order to avoid unnecessary denials for this reason, the provider should ensure that the physician’s orders cover all the services to be billed prior to billing Medicare. When responding to an Additional Documentation Request (ADR), ensure that all orders for services billed are included with the medical records.
- Code of Federal Regulations, 42 CFR – Sections 410.27 and 424.5
- CMS Internet-Only Manuals (IOMs) Medicare Claims Processing Manual, Publication 100-04, Chapter 17, Sections 90.2 (PDF, 538 KB)