Active Service-Specific Postpayment Medical Reviews

Published 01/22/2021

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Code Type
Specific Code
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Part A
HCPCS
J9271
Pembrolizumab (Keytruda®)
Review of Outpatient Claims for Pembrolizumab
Part A
HCPCS
J2505
Pegfilgrastim, 6mg
Review of Outpatient Claims for Pegfilgrastim, 6mg
Part A
HCPCS
J9311/ J9312
Rituximab 10 mg and Hyaluronidase/Rituximab, 10 mg
Review of Outpatient Claims for Rituximab 10 mg and Hyaluronidase / Rituximab, 10 mg
Part A
HCPCS
J9035
Bevacizumab, 10mg
Review of Outpatient Claims for Bevacizumab, 10mg
Part A
HCPCS
J9299
Nivolumab (Opdivo®)
Review of Outpatient Claims for J9299 — Nivolumab (Opdivo®)
Part A
HCPCS
J2350
Ocrelizumab (Ocrevus®), 1 mg
Review of Outpatient Claims for J2350 — Ocrelizumab (Ocrevus®), 1 mg
Part A
HCPCS
J1459
Ivig Privigen 500 mg
Review of Outpatient Claims for Ivig Privigen 500 mg
Part A
HCPCS
G0277
Hyperbaric Oxygen Therapy (HBO)
Review of Inpatient Claims for Hyperbaric Oxygen Therapy (HBO)
Part A
CPT®
97110
Therapeutic Exercise
Review of Outpatient Claims for Therapeutic Exercise
Part A
CPT®
97140
Manual Therapy
Review of Outpatient Claims for Manual Therapy
Part A
DRG
885
DRG 885 — Psychoses
Review of Inpatient Claims for DRG 885 — Psychoses
Part A
IRF
0604
Inpatient Rehabilitation Services (IRF): 0604 — Neurological M<25.85
Review of Inpatient Rehabilitation Services (IRF): 0604 — Neurological M<25.85
Part A
IRF
0106
Inpatient Rehabilitation Services (IRF): 0106 — Stroke M<41.50 & A<84.50
Review of Inpatient Rehabilitation Services (IRF): 0106 — Stroke M<41.50 & A<84.50
Part A
Bill Type
72X
ESRD Renal Dialysis
Review of Claims for Bill type of 72X ESRD — Renal Dialysis
Part B
CPT®
66984
HCPCS 66984 — Extracapsular Cataract Removal with Insertion”.
Review of Outpatient Claims for CPT® 66984 — Extracapsular Cataract Removal with Insertion
Part B
HCPCS
J0897
HCPCS J0897 Prolia®
Review of Outpatient Claims for HCPCS J0897 Prolia
Part B
HCPCS
J0178
Afibercept (Eylea®) HCPCS J0178
Review of Outpatient Claims for Afibercept (Eylea) HCPCS J0178
Part B
CPT®
90960–90963
ESRD — Monthly Outpatient ESRD-Related Services
Review of Outpatient ESRD Claims with CPT® Codes 90960–90963
Part B
HCPCS
A0426/A0428
Ambulance Services: A0426/A0428 — Ambulance Services (Non-Emergent)
Review of Ambulance Claims for Ambulance Service Non Emergent, Emergency Transport/Ground Mileage with the Following HCPCSs
Part B
HCPCS
A0427/A0429
Ambulance Service, Advanced Life Support, Emergency Transport/Ambulance Service, Basic Life Support, Emergency Transport/Ground Mileage
Review of Ambulance Claims for Ambulance Service, Advanced Life Support, Emergency Transport/Ambulance Service, Basic Life Support, Emergency Transport/Ground Mileage with the Following HCPCSs
Part B
CPT®
93306
Echocardiography with Contrast
Review of Outpatient Claims for Echocardiography with Contrast
Part B
HCPCS
G6042
Assay of Amphetamines
Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6042 — Assay of Amphetamines
Part B
HCPCS
G6031
Assay of Benzodiazepines
Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6031 — Assay of Benzodiazepines
Part B
HCPCS
G6044
Assay of Cocaine
Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6044 — Assay of Cocaine
Part B
HCPCS
G6053
Assay of Methadone
Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6050 — Assay of Methadone
Part B
HCPCS
G0477–G0483
Diagnostic Services: Clinical Labs
Review of Controlled Substances and Drugs-of-Abuse Testing
Part B
HCPCS
G6056
Assay of Opiates
Review of Outpatient Claims for Drugs of Abuse Laboratory Tests: HCPCS G6056 — Opiates