Top denial reasons for codes L1900-L1990, L2000, L2005, L2010-L2136, L4350-L4387, L4396-L4397, L4631:

• The medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
• The HCPCS code on the claim is not correct for the item(s) billed.
• Medical records don't confirm that the coverage criteria have been met for an orthotic used during ambulation.
• The claim was submitted with an incorrect modifier.

Top denial reasons for codes E0163 & E0165:

• The documentation doesn't include a valid standard written order (SWO).
• The medical record doesn't support that 1 of the 3 criteria have been met for a commode.
• No medical record documentation was received.
• This item or service is denied non-covered.

Top denial reasons for A7027-A7034, A7044, E0601:

• Payment for supplies billed above normal policy usage is being denied due to lack of documentation to support that they are reasonable and necessary.
• The standard written order (SWO) is missing a description of the item.
• Documentation doesn't include a valid sleep study that meets all LCD requirements.
• Documentation doesn't include a valid in-person evaluation that meets all LCD requirements.

Top denial reasons for codes B4034, B4035, B4149, B4150, B4152-B4155, B4157-B4162:

• The claim is billed for greater quantity than the order indicates.
• The medical record doesn't specify why a standard formula cannot be used to meet the beneficiary's metabolic needs.
• Documentation doesn't include a valid standard written order (SWO).

Top denial reasons for codes J1559, J1569, J1575:

• Medical records don't confirm a diagnosis of primary immune deficiency disorder or chronic inflammatory demyelinating polyneuropathy (CIDP) that has responded to IVIG treatment.

Top denial reasons for codes A4233-A4236, A4239, A4253, A4256, A4258, A4259, E0607, E2103:

• The medical record doesn't support the beneficiary had an in-person or Medicare-approved telehealth visit with their treating practitioner to assess adherence to their continuous glucose monitor (CGM) regimen and diabetes treatment plan every 6 months following the initial prescription of the CGM.
• The medical record documentation does not support the beneficiary had an in-person or Medicare-approved telehealth visit with their treating practitioner to evaluate their diabetes control and determined that criteria are met within 6 months prior to ordering the continuous glucose monitor (CGM).
• No medical record documentation was received.

Top denial reasons for codes E0260, E0261, E0303:

• Medical records don't support the beneficiary requires frequent changes in body position or has an immediate need for a change in body position.
• Medical records don't support that 1 of the 4 criteria for a fixed height hospital bed was met.
• The medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
• The standard written order (SWO) is missing a description of the item.
• Documentation doesn't include a valid standard written order (SWO).

Top denial reasons for codes J7502, J7503, J7507, J7517, J7518, J7520, J7527:

• Documentation doesn't include information that supports that the beneficiary had a Medicare approved transplant per LCD or policy article requirements.
• The standard written order (SWO) is missing a description of the item.
• Documentation doesn't include a valid standard written order (SWO).
• No medical record documentation was received.

Top denial reasons for codes L1832, L1833, L1834, L1836, L1843, L1844, L1845, L1850, L1851, L1852, L1860, L2397:

• The file doesn't include medical records that support an examination of knee instability and an objective description of joint laxity (for example: joint testing, anterior draw, posterior draw, valgus, or varus test) from the treating practitioner.
• The documentation doesn't include a valid standard written order (SWO).
• The medical record doesn't support the beneficiary had a recent injury or a surgical procedure on the knee.

Top denial reasons for codes A6521, A6523, A6525, A6527, A6529, A6553, A6555, A6610, A6556, A6557, A6558, A6565, A6574, A6576, A6577, A6579, A6580:

• The item is non-covered because it's not deemed medically necessary.
• The file doesn't include a valid Advance Beneficiary Notice.

Top denial reasons for codes K0001-K0004:

• Medical records don't document that the beneficiary either has sufficient upper extremity function and other physical and mental capabilities needed to, in the home during a typical day, safely self-propel the manual wheelchair that is provided or has a caregiver who is available, willing, and able to provide assistance with the wheelchair.
• The home assessment didn't address the physical layout of the home, surfaces to be traversed and/or obstacles.
• Records don't document that the beneficiary's condition requires a K0003 due to the inability to self-propel a standard wheelchair in the home and that the beneficiary can and does self-propel a lightweight wheelchair.
• Neither the medical records nor supplier documentation included a home assessment.

Top denial reasons for codes J7605, J7606, J7613, J7620, J7626, J7677:

• No medical record documentation was received.
• The number of units listed on the claim is above the LCD policy allowance.
• The medical record doesn't support the beneficiary has obstructive pulmonary disease.

Top denial reasons for codes E0747, E0748, E0760:

• The medical record documentation doesn't confirm 1 of the 3 criteria have been met for a spinal electrical osteogenesis stimulator.
• No medical record documentation was received.
• The documentation doesn't include a valid standard written order (SWO).
• The documentation doesn't include a valid face-to-face encounter that meets the requirements as outlined in the LCD-related Standard Documentation Requirements Article A55426.
• The medical record documentation doesn't confirm 1 of the 3 criteria have been met for a non-spinal electrical osteogenesis stimulator.

Top denial reasons for codes E0424, E0439, E1390, E1391:

• The medical record doesn't support the treating practitioner evaluated the results of a qualifying blood gas study performed.
• The medical record doesn't include a blood gas study.
• The medical record doesn't support any of the Group I criteria.
• The documentation doesn't include a valid standard written order (SWO).

Top denial reasons for codes E0650, E0651, E0652:

• Medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
• The standard written order (SWO) is missing a description of the item.
• The documentation doesn't include a valid standard written order (SWO).

Top denial reasons for codes E0184, E0185:

• The medical record doesn't support the coverage criteria for a Group 1 pressure reducing support surface has been met.
• No medical record documentation was received.
• The medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
• The standard written order (SWO) is missing a description of the item.
• The documentation doesn't include a valid standard written order (SWO).

Top denial reasons for codes L0450-L0651:

• Medical records don't support one of the 4 criteria for a spinal orthosis.
• The code on the claim is not correct for the items billed.
• The medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.

Top denial reasons for codes A6010, A6021, A6196-A6199, A6203, A6209-A6212, A6231-A6233, A6234-A6241, A6242-A6248, A6251-A6256:

• Medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
• The size of the wound in the medical records doesn't support the code being billed.
• Surgical dressings applied to wounds closed with skin adhesive will be denied as not reasonable and necessary.

Top denial reasons for codes A5500, A5512, A5513:

• The medical record doesn't include a clinical foot evaluation either conducted by the certifying physician or approved, initialed, and dated by the certifying physician. Therefore, there is no verification that the beneficiary had one of the 6 conditions the LCD specifies must be present for coverage.
• The file doesn't include medical records from the certifying physician.
• Documentation didn't include a Statement of Certifying Physician.

Top denial reasons for codes A4295, A4296, A4297, A4316, A4351, A4352, A4353, A4355:

• The medical record doesn't document the medical necessity for a coude (curved) tip catheter. (Example: An inability to catheterize with a straight tip catheter).
• Medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
• The documentation doesn't include a valid standard written order (SWO).
• Records don't support payment of the amount billed.
• The standard written order (SWO) is missing a description of the item.