Denial Reason, Reason/Remark Code(s)
• M-80: Not covered when performed during the same session/date as a previously processed service for the patient
• CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
• CPT code: 82565
National Correct Coding Initiative
The National Correct Coding Initiative (NCCI) packages/bundles reimbursement for some services under Medicare. NCCI identifies code pairs that are never reimbursed separately and code pairs that can only be reimbursed separately in certain circumstances (identified by the appropriate modifier).
• Check NCCI edits prior to claim submission; edits are updated quarterly. NCCI edits are available on the CMS website.
• Use the Palmetto GBA NCCI tool to determine if the service you are submitting is bundled with another service
• CPT code 82565 is bundled with CPT code 80047. CPT code 82565 is also bundled with CPT codes 80048, 80053, 80069 and 82575.
o For these combinations of services, CPT code 82565 is designated with indicator ‘1’ in the CCI edit list. If this is a separate, distinct service, submit CPT modifier 59 to denote it as a separate service.
Examples of separate, distinct services include tests that are performed different patient encounters. Supporting documentation is required in the medical records.
• For additional, specific information on modifiers that may be used to denote exceptions to CCI (including CPT modifier 59), refer to the Palmetto GBA Modifier Lookup tool.