Medical Review Pre-Payment Reviews: April 2023 to March 2024 Planned Reviews
Palmetto GBA Railroad Medicare’s Medical Review (MR) department is conducting prepayment reviews.
An Additional Documentation Request (ADR) letter, asking for the records for a specific claim, will be sent on each claim selected for review. MR clinicians are reviewing your claim and the additional documentation which you submit. The reason for record review is to confirm that services were rendered according to the Medicare guidelines for medical reasonableness and necessity. Providers can expect review completion within 30 days of MR’s receipt of the requested documentation for prepay claims.
A Remittance Advice (RA) will be generated after MR makes a determination on the claim. The RA will explain if the claim was allowed at the level billed, allowed but at an up-coded or down-coded level, or if the claim was denied. Railroad Medicare will also determine liability for denied services.
April 2023 – March 2024 Planned Pre-Payment Reviews
| Type of Service | CPT®/HCPCS Code | Code Description |
|---|---|---|
| Ambulance | A0425 | BLS/ALS mileage, per statue mile (in combination with transport codes) |
| Ambulance | A0427 | ALS1, emergency |
| Ambulance | A0429 | BLS, emergency |
| Ambulance | A0431 | Rotary wing air transport |
| Ambulance | A0436 | Rotary wing air mileage, per statute mile (in combination with air transport code) |
| Echocardiography | 93306 | Echocardiography, transthoracic, real-time with image documentation |
| Ophthalmology Surgical Services | 66894 | Extracapsular cataract removal with insertion |
| Radiology | 71045 | X-ray exam chest 1 view |
| Radiology | 71046 | X-ray exam chest 2 views |
| Radiology | 71260 | Diagnostic imaging procedures of the chest |
| Radiology | 77080 | DXA, bone density, axial |
| Therapy | 97110 | Therapeutic exercises |
| Therapy | 97112 | Neuromuscular reeducation |
| Therapy | 97113 | Aquatic therapy/exercises |
| Therapy | 97116 | Gait training therapy |
| Therapy | 97140 | Manual therapy, 1/> regions |
| Therapy | 97150 | Group therapeutic procedures |
CPT® codes, descriptors and other data only are copyright 2022 American Medical Association. All rights reserved.
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