RESOLVED: Claims for ICD-10-CM Code M54.5 Denying in Error

RESOLVED: Claims for ICD-10-CM Code M54.5 Denying in Error

Current Status



Resolved 10/21/2021 Status: All claims that were affected have been adjusted as of October 21, 2021. 
Provider Action: There is no provider action necessary. 



Status: Palmetto GBA isolated the processing issue and will initiate a mass adjustment for claims submitted on or after 9/3/2021, within the next 60 days.

Provider Action: No provider action is necessary.



Issue Description

Some outpatient rehabilitation claims (74x type of bill) that reported ICD-10-CM code M54.5 on or after September 3, 2021, were denied in error with reason code 55503 citing either LCD 334427 — Outpatient Occupational Therapy or L34428 — Outpatient Physical Therapy.

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Last Updated: 11/09/2021