1364 Review Code

Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service

Batch

Element Details

Type ID

LengthMin 1 / Max 2

Codes

<>L
Reserved for Local Assignment
<>N
Reserved for National Assignment
<>A
Case Turned Over to a Consultant
<>D
Provider/Supplier determined the service is not covered, but the patient is requesting a formal review by the payor
<>B
Pre-Admission Testing
<>E
Beneficiary was notified that the item might not be considered medically necessary and has agreed in writing to pay for the item; A signed waiver is on file with the provider
<>C
X-ray or Lab Procedure Related to a Covered Surgery
<>F
Beneficiary was notified that the item might not be considered medically necessary and has not agreed to pay for the item; No signed waiver is on file with the provider