Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service
Type
ID
Length
Max 2 / Min 1
Codes
<> A
Case Turned Over to a Consultant
<> B
Pre-Admission Testing
<> C
Xray or Lab Procedure Related to a Covered Surgery
<> D
Provider/Supplier determined the service is not covered, but the patient is requesting a formal review by the payor
<> E
Beneficiary was notified that the item might not be considered medically necessary and has agreed in writing to pay for the item. A signed waiver is on file with the provider
<> F
Beneficiary was notified that the item might not be considered medically necessary and has not agreed to pay for the item. No signed waiver is on file with the provider
