K0005: Reasons for Medicare Denials

RemitDATA provided the following Medicare funding statistics for ultralightweight manual chairs, HCPCS code K0005, from Dec. 16, 2013, through March 24, 2014.

Data used for analysis: Electronic remittance advice (ANSI 835), service line detail. Unexpected denial rate: 18 percent Top reasons for unexpected denials according to RemitDATA:

  1. OA18: Other Adjustment — Duplicate claim/service.
  2. CO16: Contract Obligation — Claim service lacks information needed for adjudication.
  3. CO4: Contract Obligation — The procedure code is inconsistent with the modifier used or a required modifier is missing.
  4. CO15: Contract Obligation — The authorization number is missing, invalid, or does not apply to the billed services or provider.
  5. CO29: Contract Obligation — Time limit for filing is expired.

This article originally appeared in the May 2014 issue of Mobility Management.

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