Active Service Specific Postpayment Medical Reviews


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Code Type
Specific Code
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Home Health
HIPPS
All
Home Health Services for Eligibility and Medical Necessity
Review of claims submitted for Home Health Services for Eligibility and Medical Necessity
Hospice
Rev Code
General Inpatient Care (GIP)
General Inpatient Care (GIP)
Review of Inpatient claims for Inpatient Hospice Care greater than or equal to 7 days for Revenue Code 656 and place of service codes Q5004 - Q5009
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
J1745
Infliximab (Remicade®)
Review of Outpatient claims for Infliximab (Remicade®)
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
97112
Neuromucular Reeducation
Review of Outpatient claims for Rehabilitation Services: 97112 - Neuromucular Reeducation
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
2004
Inpatient Rehabilitation Services (IRF): 2004 –
Review of Inpatient Rehabilitation Services (IRF): 2004 –
Part A
CPT
77301
Intensity Modulated Radiotherapy (IMRT) Planning
Review of Outpatient claims for Diagnostic Imaging: CPT Codes 77301 – Intensity Modulated Radiotherapy (IMRT) Planning
Part A
CPT
77338
MLC Device(s) for IMRT
Review of Outpatient claims for Diagnostic Imaging: CPT Code 77338 – MLC Device(s) for IMRT
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
CPT
97110
Therapeutic Exercise
Review of Outpatient claims for Therapeutic Exercise
Part B
HCPCS
J0897
HCPCS J0897 Prolia
Review of Outpatient claims for HCPCS J0897 Prolia
Part B
HCPCS
J2778
Lucentis (Ranibizumab)
Review of Outpatient claims for Lucentis (Ranibizumab)
Part B
HCPCS
J1745
Infliximab (Remicade)
Review of Outpatient claims for Infliximab (Remicade)
Part B
HCPCS
J0178
Afibercept (Eylea) HCPCS J0178
Review of Outpatient claims for Afibercept (Eylea) HCPCS J0178
Part B
HCPCS
J9311/J9312
Rituximab (Rituxan®)
Review of Outpatient claims for J9311 and J9312 – Rituximab (Rituxan®)
Part B
HCPCS
J0717
Certolizumab (Cimzia®)
Review of Outpatient claims for J0717 Certolizumab (Cimzia®)
Part B
HCPCS
J0129
Abatacept (Orencia®)
Review of Outpatient claims for J0129 Abatacept (Orencia®)
Part B
CPT
11042-11047
Surgical Debridement
Review of Outpatient claims for Surgical Services: 11042-11047 – Surgical Debridement
Part B
CPT
90960-90963
ESRD-Monthly Outpatient ESRD -Related Services
Review of Outpatient ESRD claims with CPTs 90960-90963
Part B
HCPCS
A0427/A0429/A0425
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
Part B
CPT
82542
Column Chromatography/Mass Spectrometry
Review of Outpatient claims for Drugs of Abuse Laboratory Tests: CPT 82542-Column Chromatography/Mass Spectrometry




Last Updated: 01/22/2021