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

1. The code on the claim is not correct for the items billed.
2. The medical records do not confirm that the coverage criteria have been met for an orthotic used during ambulation.
3. The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
4. The documentation does not contain a valid standard written order (SWO).

Top denial reasons for A7027-A7034, A7044, E0601

1. The documentation does not contain a valid standard written order (SWO).
2. Payment for supplies billed above normal policy usage is being denied due to lack of documentation to support that they are reasonable and necessary.
3. The documentation was not timely (within the preceding 12 months) to support continued need by the beneficiary.
4. Documentation does not include a valid in-person evaluation that meets all LCD requirements.
5. Documentation does not include a valid sleep study that meets all LCD requirements.

Top denial reasons for code B4035

1. The claim is billed for greater quantity than the order indicates.
2. Payment for supplies or items billed in excess of the quantity considered to be reasonable and necessary is being denied.
3. The medical record documentation does not specify why a standard formula cannot be used to meet the beneficiary's metabolic needs.

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

1. The medical record documentation does not 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.
2. No medical record documentation was received.
3. The KX modifier was incorrectly appended. The medical record documentation supports the beneficiary is non-insulin treated.

Top denial reasons for codes E0260, E0261, E0303

1. No medical record documentation was received.
2. Medical records do not support that the beneficiary requires frequent changes in body position or has an immediate need for a change in body position.
3. The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
4. The standard written order (SWO) is missing a description of the item.
5. The documentation does not contain a valid standard written order (SWO).

Top denial reasons for codes J7503, J7507, J7518, J7520, J7527

1.  No medical record documentation was received.
2. The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
3. The claim is billed for greater quantity than the order indicates.
4. The documentation does not contain a valid standard written order (SWO).

Top denial reasons for codes L1832, L1833, L1843, L1844, L1845, L1851, L1852, L2397

1. The file does not 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.
2. The medical record does not contain one of the diagnoses required by the LCD.
3. The file does not contain a valid Advance Beneficiary Notice of Noncoverage.

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

1. The item is non-covered because it is not deemed medically necessary.
2. The file does not contain a valid Advance Beneficiary Notice of Noncoverage.

Top denial reasons for codes K0001-K0004

1. The medical records do not 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.
2. The home assessment did not address the physical layout of the home, surfaces to be traversed and/or obstacles.
3. Neither the medical records nor supplier documentation included a home assessment.

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

1.  No medical record documentation was received.
2. The number of units listed on the claim is above the LCD policy allowance.
3. The medical record documentation does not support the beneficiary has obstructive pulmonary disease.

Top denial reasons for codes E0747, E0748, E0760

1. The medical record documentation does not confirm one of the three criteria have been met for a non-spinal electrical osteogenesis stimulator.
2. The documentation does not contain a valid written order prior to delivery.
3. The documentation does not include a valid face-to-face encounter that meets the requirements as outlined in the LCD-related Standard Documentation Requirements Article A55426.
4. The medical record documentation does not confirm one of the three criteria have been met for a spinal electrical osteogenesis stimulator.

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

1.  The medical record documentation does not include a blood gas study.
2. The medical record documentation does not support the treating practitioner has evaluated the results of a qualifying blood gas study performed.
3. The medical record documentation does not support any of the Group I criteria.
4. The medical record documentation does not support the blood gas study was obtained within 2 days prior to discharge from an inpatient hospital stay.

Top denial reasons for codes E0650, E0651, E0652

1.  The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
2. The documentation does not contain a valid standard written order (SWO).
3. No medical record documentation was received.

Top denial reasons for codes E0184, E0185

1. The medical record documentation does not support the coverage criteria for a Group 1 pressure reducing support surface has been met.
2.  The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
3. The documentation does not contain a valid standard written order (SWO).

Top denial reasons for codes L0450-L0651

1. The code on the claim is not correct for the items billed.
2. Medical records do not support one of the four criteria for a spinal orthosis.
3. No medical record documentation was received.
4. The file does not contain a valid Advance Beneficiary Notice of Noncoverage.
5. The documentation submitted indicates the item(s) were returned by the beneficiary.

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

1. The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.
2. The size of the wound in the medical records does not support the code being billed.
3. Medical records show surgical dressings were applied to wounds closed with skin adhesive, which is not reasonable and necessary.

Top denial reasons for codes A5500, A5512, A5513

1. Medical record documentation does not 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.
2. The file does not include medical records from the certifying physician.
3. Documentation did not include a Statement of Certifying Physician.

Top denial reasons for codes A4316, A4351, A4352, A4353, A4355

1. Records do not support payment of the amount billed.
2. The submitted medical records do not document the medical necessity for a coude (curved) tip catheter. (Example: An inability to catheterize with a straight tip catheter).
3. The medical records from the treating practitioner do not document an impairment of urination.
4. The documentation does not contain a valid Standard Written Order (SWO).