Active Service Specific Postpayment Medical Reviews


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Code Type
Specific Code
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Part A
HCPCS
J9271
Pembrolizumab (Keytruda)
Review of Outpatient claims for Pembrolizumab
Part A
HCPCS
J2505
Pegfilgrastim, 6mg
Review of Outpatient claims for Pegfilgrastim, 6mg
Part A
HCPCS
J9311/ J9312
Rituximab 10 mg and Hyaluronidase/Rituximab, 10 mg
Review of Outpatient claims for Rituximab 10 mg and Hyaluronidase/Rituximab, 10 mg
Part A
HCPCS
J9035
Bevacizumab, 10mg
Review of Outpatient claims for Bevacizumab, 10mg
Part A
HCPCS
J9299
Nivolumab (Opdivo®)
Review of Outpatient claims for J9299 – Nivolumab (Opdivo®)
Part A
HCPCS
J2350
Ocrelizumab (Ocrevus®), 1 mg
Review of Outpatient claims for J2350 – Ocrelizumab(Ocrevus®), 1 mg
Part A
HCPCS
J1459
Ivig Privigen 500 mg
Review of Outpatient claims for  Ivig Privigen 500 mg
Part A
HCPCS
G0277
Hyperbaric Oxygen Therapy (HBO)
Review of Inpatient claims for Hyperbaric Oxygen Therapy (HBO)
Part A
CPT
97110
Therapeutic Exercise
Review of Outpatient claims for Therapeutic Exercise
Part A
CPT
97140
Manual Therapy
Review of Outpatient claims for Manual Therapy
Part A
DRG
885
DRG 885 – Psychoses
Review of Inpatient claims for DRG 885 – Psychoses
Part A
IRF
0604
Inpatient Rehabilitation Services (IRF): 0604 – Neurological M<25.85
Review of Inpatient Rehabilitation Services (IRF): 0604 – Neurological M<25.85
Part A
IRF
0106
Inpatient Rehabilitation Services (IRF): 0106 – Stroke M<41.50 & A<84.50
Review of Inpatient Rehabilitation Services (IRF): 0106 – Stroke M<41.50 & A<84.50
Part A
Bill Type
72X
ESRD Renal Dialysis
Review of claims for Bill type of 72X ESRD- Renal Dialysis
Part B
CPT
66984
HCPCS 66984-Extracapsular Cataract Removal with Insertion”.
Review of Outpatient claims for CPT 66984-Extracapsular Cataract Removal with Insertion”.
Part B
HCPCS
J0897
HCPCS J0897 Prolia
Review of Outpatient claims for HCPCS J0897 Prolia
Part B
HCPCS
J0178
Afibercept (Eylea) HCPCS J0178
Review of Outpatient claims for Afibercept (Eylea) HCPCS J0178
Part B
CPT
90960-90963
ESRD-Monthly Outpatient ESRD -Related Services
Review of Outpatient ESRD claims with CPTs 90960-90963
Part B
HCPCS
A0426/A0428
Ambulance Services: A0426/A0428 - Ambulance Services (Non-Emergent)
Review of ambulance claims for Ambulance Service Non Emergent, Emergency Transport/Ground Mileage with the following HCPCSs
Part B
HCPCS
A0427/A0429
Ambulance Service, Advanced Life Support, Emergency Transport/Ambulance Service, Basic Life Support, Emergency Transport/Ground Mileage
Review of ambulance claims for Ambulance Service, Advanced Life Support, Emergency Transport/Ambulance Service, Basic Life Support, Emergency Transport/Ground Mileage with the following HCPCSs
Part B
CPT
93306
Echocardiography with Contrast
Review of Outpatient claims for Echocardiography with Contrast
Part B
HCPCS
G6042
Assay of Amphetamines
Review of Outpatient claims for Drugs of Abuse Laboratory Tests: HCPCS G6042 - Assay of Amphetamines
Part B
HCPCS
G6031
Assay of Benzodiazepines
Review of Outpatient claims for Drugs of Abuse Laboratory Tests: HCPCS G6031 - Assay of Benzodiazepines
Part B
HCPCS
G6044
Assay of Cocaine
Review of Outpatient claims for Drugs of Abuse Laboratory Tests: HCPCS G6044 - Assay of Cocaine
Part B
HCPCS
G6053
Assay of Methadone
Review of Outpatient claims for Drugs of Abuse Laboratory Tests: HCPCS G6050 - Assay of Methadone
Part B
HCPCS
G0477 - G0483
Diagnostic Services: Clinical Labs
Review of controlled substances and drugs-of-abuse testing
Part B
HCPCS
G6056
Assay of Opiates
Review of Outpatient claims for Drugs of Abuse Laboratory Tests: HCPCS G6056 - Opiates





Last Updated: 01/22/2021