Incorrect Reimbursement: Physical Medicine / Chiropractic / Acupuncture
For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review and including IBR decisions as supporting documentation.
Official Medical Fee Schedule
Physician Services
CPT Code(s)
Physical Medicine / Chiropractic / Acupuncture Multiple Procedure Payment Reduction; Pre-Authorization for Specified Procedure / Modality Services
Payable
Yes
EOR Denial Reason
Maximum units exceeded.
Second Review Reason (SBR-1)
Recommended Reason
MUE incorrectly cited as reason for $0 reimbursement. § 9789.12.13 Correct Coding Initiative.
(c) Medically Unlikely Edits are published by CMS on its website at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html document “Practitioner Services MUE Table.” See section 9789.19 for the adopted version of the Practitioner Services MUE Table, by date of service.
DaisyBill Resources
Webinar: Request for Second Review
Webinar: Second Review Strategy Kit, Part I
Webinar: Second Review Strategy Kit, Part II
DaisyBill Solution
Every request for Second Review submitted from DaisyBill is compliantly submitted using both a completed DWC Form SBR-1, as well as a compliant modified CMS 1500.
Was this article helpful?
DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.
Drop us a line with any news you would like us to share or any issue that concerns you.
