Active Service-Specific Postpayment Medical Reviews
Published 01/22/2021
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Code Type
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Specific Code
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Part A
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HCPCS
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J9271
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Pembrolizumab (Keytruda®)
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Review of Outpatient Claims for Pembrolizumab
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Part A
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HCPCS
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J2505
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Pegfilgrastim, 6mg
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Review of Outpatient Claims for Pegfilgrastim, 6mg
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Part A
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HCPCS
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J9311/ J9312
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Rituximab 10 mg and Hyaluronidase/Rituximab, 10 mg
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Review of Outpatient Claims for Rituximab 10 mg and Hyaluronidase / Rituximab, 10 mg
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Part A
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HCPCS
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J9035
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Bevacizumab, 10mg
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Review of Outpatient Claims for Bevacizumab, 10mg
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Part A
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HCPCS
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J9299
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Nivolumab (Opdivo®)
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Review of Outpatient Claims for J9299 — Nivolumab (Opdivo®)
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Part A
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HCPCS
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J2350
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Ocrelizumab (Ocrevus®), 1 mg
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Review of Outpatient Claims for J2350 — Ocrelizumab (Ocrevus®), 1 mg
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Part A
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HCPCS
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J1459
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Ivig Privigen 500 mg
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Review of Outpatient Claims for Ivig Privigen 500 mg
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Part A
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HCPCS
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G0277
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Hyperbaric Oxygen Therapy (HBO)
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Review of Inpatient Claims for Hyperbaric Oxygen Therapy (HBO)
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Part A
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CPT®
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97110
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Therapeutic Exercise
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Review of Outpatient Claims for Therapeutic Exercise
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Part A
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CPT®
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97140
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Manual Therapy
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Review of Outpatient Claims for Manual Therapy
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Part A
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DRG
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885
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DRG 885 — Psychoses
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Review of Inpatient Claims for DRG 885 — Psychoses
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Part A
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IRF
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0604
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Inpatient Rehabilitation Services (IRF): 0604 — Neurological M<25.85
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Review of Inpatient Rehabilitation Services (IRF): 0604 — Neurological M<25.85
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Part A
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IRF
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0106
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Inpatient Rehabilitation Services (IRF): 0106 — Stroke M<41.50 & A<84.50
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Review of Inpatient Rehabilitation Services (IRF): 0106 — Stroke M<41.50 & A<84.50
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Part A
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Bill Type
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72X
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ESRD Renal Dialysis
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Review of Claims for Bill type of 72X ESRD — Renal Dialysis
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Part B
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CPT®
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66984
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HCPCS 66984 — Extracapsular Cataract Removal with Insertion”.
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Review of Outpatient Claims for CPT® 66984 — Extracapsular Cataract Removal with Insertion
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Part B
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HCPCS
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J0897
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HCPCS J0897 Prolia®
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Review of Outpatient Claims for HCPCS J0897 Prolia
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Part B
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HCPCS
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J0178
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Afibercept (Eylea®) HCPCS J0178
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Review of Outpatient Claims for Afibercept (Eylea) HCPCS J0178
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Part B
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CPT®
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90960–90963
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ESRD — Monthly Outpatient ESRD-Related Services
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Review of Outpatient ESRD Claims with CPT® Codes 90960–90963
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Part B
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HCPCS
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A0426/A0428
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Ambulance Services: A0426/A0428 — Ambulance Services (Non-Emergent)
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Review of Ambulance Claims for Ambulance Service Non Emergent, Emergency Transport/Ground Mileage with the Following HCPCSs
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Part B
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HCPCS
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A0427/A0429
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Ambulance Service, Advanced Life Support, Emergency Transport/Ambulance Service, Basic Life Support, Emergency Transport/Ground Mileage
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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
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Part B
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CPT®
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93306
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Echocardiography with Contrast
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Review of Outpatient Claims for Echocardiography with Contrast
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Part B
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HCPCS
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G6042
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Assay of Amphetamines
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Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6042 — Assay of Amphetamines
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Part B
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HCPCS
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G6031
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Assay of Benzodiazepines
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Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6031 — Assay of Benzodiazepines
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Part B
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HCPCS
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G6044
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Assay of Cocaine
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Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6044 — Assay of Cocaine
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Part B
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HCPCS
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G6053
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Assay of Methadone
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Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6050 — Assay of Methadone
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Part B
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HCPCS
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G0477–G0483
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Diagnostic Services: Clinical Labs
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Review of Controlled Substances and Drugs-of-Abuse Testing
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Part B
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HCPCS
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G6056
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Assay of Opiates
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Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6056 — Opiates
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