36342

FISS Narrative:
A portion of the submitted charges should be non-covered because an HCPCS on this ESRD claim did not have the requested justification.

Explanation and Suggestion:

  • This reason code indicates that the provider is billing for a drug, lab test or other service that requires additional information be submitted as medical justification
  • Most frequently, this means that a required diagnosis code is not present
  • The provider can determine the service in question by going to Page 2 (the revenue lines/charges page in FISS DDE) and pressing PF2/F2
  • This should bring to your screen the line item with the HCPCS/CPT code that needs justification
  • Please correct and resubmit/rekey
  • Hardcopy submitters resubmit RTP report with corrections

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

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