Medicare NOC AND MSP CODE - AVOIDING DENIAL AND APPEAL

Way to avoid appeal

Enter the concise description of an unlisted procedure code (an NOC code) or a “not otherwise classified” code. Failure to describe the NOC or other scenarios listed below will result in a denial.

    * The description must be entered into block 19 of the CMS-1500 (08-05) claim form or in the Extra Narrative Data segment (Loop 2300/2400) of the ANSI ASC X12 837 Versions of an electronic claim.  This block/segment is also used to describe other billing scenarios listed below.

    * Enter the drug’s name and dosage.
    * Enter all applicable modifiers when modifier –99(multiple modifiers) is entered.
    * Enter the statement, “Testing for hearing aid,” when billing services involving the testing of a hearing aid(s) is used to obtain intentional denials when other payers are involved.
    * When dental examinations are billed, enter the specific surgery for which the exam is being performed.
    * Enter the specific name and dosage amount when low osmolar contrast material is billed, but only if HCPCS codes do not cover them.
    * Enter the date for a global surgery claim when providers share post-operative care.




 When Medicare is the secondary payer (MSP) the claim must include information from the primary insurer. Failure to include this information will result in a denial.

   
    * To submit MSP claims electronically, please refer to the MSP loop and other inforamtion (ANSI) Implementation Guide.

    * Please note it is the provider's responsibility to obtain primary insurance information from the beneficiary and bill Medicare appropriately. Claim filing extensions will not be granted because of incorrect insurance information