Denial Reason, Reason/Remark Code(s)
• M-80: Not covered when performed during the same session/date as a previously processed service for the patient
• CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
• CPT code: 82565
National Correct Coding Initiative
The National Correct Coding Initiative (NCCI) packages or 'bundles' reimbursement for some services under Medicare. NCCI identifies code pairs that are never reimbursed separately and code pairs that can only be reimbursed separately in certain circumstances (identified by the appropriate modifier).
• Check NCCI edits prior to claim submission; edits are updated quarterly. NCCI edits are available at www.cms.gov/NationalCorrectCodInitEd/.
• Use the Palmetto GBA NCCI tool to determine if the service you are submitting is bundled with another service
• CPT code 82565 is bundled with CPT code 80047. CPT code 82565 is also bundled with the following CPT codes: 80048, 80053, 80069 and 82575.
o For these combinations of services, CPT code 82565 is designated with indicator '1' in the CCI edit list. If this is a separate, distinct service, submit CPT modifier 59 to denote it as a separate service.
Examples of separate, distinct services include tests that are performed different patient encounters. Supporting documentation is required in the medical records.
• For additional, specific information on modifiers that may be used to denote exceptions to CCI (including CPT modifier 59), refer to the Palmetto GBA Modifier Lookup tool:
o Jurisdiction 1: Select 'Articles' on the left side of the Palmetto GBA Web page
o Ohio, South Carolina and West Virginia: Select 'Browse by Topic' on the left side of the Palmetto GBA Web page
Common Reasons for Message
Combination of codes billed on same date of service by same provider may not be appropriately paired together due to National Correct Coding Initiative (NCCI) Edits
Payment for service billed is bundled into payment for another service performed that day
It is unusual for services billed to be performed together
Modifier used to unbundle is on incorrect code or incorrect modifier was used
Verify code set is appropriate to be billed together
Submit Appeal request to add modifier, if appropriate
See Appeals webpage for instructions on how to submit a Reopening or Redetermination
Claim Submission Tips
Review NCCI Coding Edits External Link prior to submitting claim to determine if codes are appropriately paired
View How to Use Medicare NCCI Tools External Link
When appropriate, modifier to identify separately identifiable service should be appended to Column 2 code
Modifier Indicator "0" – there are no circumstances in which both procedures of a code pair should be paid; modifier is not allowed for NCCI purposes
Modifier Indicator "1" – modifiers associated with NCCI are allowed with this code pair when appropriate
Modifier Indicator "9" – NCCI edit does not apply to this code pair; edit for code pair was deleted retroactively
Providers may not bill patient for NCCI edit denials
Denial is based on incorrect coding
Providers should not complete an ABN for NCCI edits