36357

FISS Narrative:
The dialysis services on this end-stage renal disease (ESRD) claim exceeded the limit routinely allowed for these dates of service and additional justification was not found.

Explanation and Suggestion:

  • The limit for dialysis visits is three per seven calendar days
  • This reason code indicates that the number of dialysis visits billed on this claim exceeds that limit for the dates of service billed, and there is no additional justification (usually a diagnosis code(s)) on the claim
  • ESRD guidelines require specific documentation when the dialysis service limits are exceeded and this documentation must be provided to pay these services
  • Please correct and resubmit/rekey
  • Hard copy submitters resubmit RTP report with corrections

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

Email Part A

Contact a specific JM Part A department

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 



spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer