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Printed Date: 9/22/2015
Payment has been reduced or denied because the maximum allowance for this ESRD service has been reached. Dialysis home support did not have the requested justification.
Explanation and Suggestion:
Verify if there is a supporting diagnosis to justify more than three treatments per week and add Remarks.
Note: Effective for Dates of Service on or after 01/01/2017, this Reason Code is bypassed on a TOB 72X (ESRD) claim identified as Acute Kidney Injury (AKI). Condition Code 84, Revenue Code 082X, 083X, 084X, or 085X with HCPCS Code G0491, and Diagnosis Code N170, N171, N172, N178, N179, N990, T795XXA, T795XXD, or T795XXS are present on the claim.
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Last Updated: 12/27/2018