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Condition Codes
Does anyone know anything about "condition codes"? We billed Medicare for a knee imobilizer,L1830, for one of our patients. They processed the claim as MA130 "unprocessable" and CO 109 "Claim not covered by this payer/contractor. Must send to correct" When I called Medicare they told me the L1830 is a DME code and I had to bill them. I called DME and they said I have to enroll to be a supplier. (We use them so little that it is not worth it.) The patient's secondary ins wants a denial from Medicare and won't accept the unprocessable EOB. I found something called a condition code 21 which "is used when submitting Medicare claims in order to receive a formal denal for purposes of billing secondary insurances". My question is: Where does this condition code 21 go on the claim/HCFA? Is it considered a modifier? Any help would be greatly appreciated!
re: Condition Codes
It does not go on a 1500 form. Condition codes are used on facility claim form UB
re: Condition Codes
Thanks so much!