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
DRG
DRG 885
Psychoses
Review of Inpatient Claims for Psychoses
Part A
HCPCS
J9271
Pembrolizumab (Keytruda)
Review of outpatient claims for Pembrolizumab
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
HCPCS
J0897
Denosumab, 1 mg
Review of outpatient claims for Denosumab, 1 mg
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
CPT
97140
Manual Therapy
Review of outpatient claims for Manual Therapy
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
HCPCS
G0477 - G0483
Diagnostic Services: Clinical Labs
Review of controlled substances and drugs-of-abuse testing
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
CPT
82542
Column Chromatography/Mass Spectrometry
Review of outpatient claims for Drugs of Abuse Laboratory Tests: CPT 82542-Column Chromatography/Mass Spectrometry
Part B
HCPCS
G6056
Opiates
Review of outpatient claims for Drugs of Abuse Laboratory Tests: HCPCS G6056 - Opiates
Part B
HCPCS
J1745
Infliximab (Remicade)
Review of outpatient claims for Infliximab (Remicade)
Part B
CPT
90960-90963
ESRD-Monthly Outpatient ESRD -Related Services
Review of outpatient ESRD claims with CPTs 90960-90963
Part B
HCPCS
J0178
Afibercept (Eylea) HCPCS J0178
Review of outpatient claims for Afibercept (Eylea) HCPCS J0178
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
CPT
97110
Rehabilitation Services
Review of claims for CPT Code 97110 – Therapeutic Exercises

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