Reason Code UFPSD

Published 02/11/2025

Description
It has been determined that one of the following scenarios applies to your unpaid claim or service line.

  • Non-covered due to a National Coverage Determination (NCD) 
  • Non-covered due to a Local Coverage Determination (LCD) 
  • Invalid billing such as inappropriate code combination, missing covered diagnosis or inappropriate modifier
  • DDE Screen MAP171D will reflect the correct Ansi Adjustment reason, group, and remarks codes. These codes will be on the provider Remittance Advice as well. 

Resolution
Review the claim for all reason codes and comments. Determine if the claim can be corrected, adjusted or if it has appeal rights. If the provider disagrees with this decision, please submit an appeal with all supporting medical documentation within 120 days of the remittance date.

Remember, providers are responsible for determining the correct diagnostic and procedural coding for the services furnished to Medicare patients. After reviewing Medicare guidelines, providers, compliance, audit and/or billing staff can find more information on coding resources in the CMS Internet-Only Manual (IOM) Publication 100-09, Beneficiary and Provider Communications Manual, Chapter 6, Section 30.1.1 (PDF).

If you have a question about interpretation of procedural and diagnostic coding, please contact the entities that have responsibility for those coding sets.

  • Current Procedural Terminology (CPT®) codes are proprietary to the American Medical Association (AMA). As such, CPT® coding questions should be referred to the AMA. The AMA offers CPT® Information Services (CPT-IS). This internet-based service is a benefit to AMA members and is available as a subscription fee-based service for non-members and nonphysicians. The AMA also offers CPT® Assistant. Information about these resources is found on the AMA's website.
     
  • The American Hospital Association (AHA) has a website with many resources for answers to coding questions. The website also has a direct link to the AHA Coding Clinic whereby coding questions may be submitted and tracked.
     
  • Level II Healthcare Common Procedure Coding System (HCPCS) codes related to durable medical equipment or prosthetics, orthotics, and supplies are answered by the Pricing, Data Analysis and Coding (PDAC) Contractor. Information about the PDAC Contractor and the services it provides can be found on the PDAC's website
     
  • Additional information can be found about these resources on the CMS HCPCS General Information web page

References


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