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CO-222 and N640

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TXBiller:
I need assistance in figuring out what the below is telling me.  Any help you can give will be greatly appreciated.

222:  Exceeds the contracted maximum number of hours/days/units by this provider for this period.  This is not patient specific.  NOTE:  Refer to the 835 Healthcare Policy Identification Segment (Loop 2110 Service Payment Information REF), if present.

N640:  Exceeds number/frequency approved/allowed within time period.

jenniferp:
What kind of CPT are you getting this denial for?

Michele:

--- Quote from: jenniferp on April 16, 2019, 05:27:24 PM ---What kind of CPT are you getting this denial for?

--- End quote ---

Yes, need more information to be able to help.

TXBiller:
Sorry about that. 

99203 with mod 25 received both CO-222 remark N640
G0444 CO-222 remark N640

kristin:
The answer is sort of right there in the denial codes. The services being billed have exceeded the amount allowed in a give time frame.

The provider has already billed a new patient E/M on this particular patient within the last 3 years, so cannot bill another one, and the provider or another provider has already billed a depression screening for this patient in the last 12 months. Medicare only allows one depression screening every 12 months for a patient.

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