ASC X12 004010

1364 Review Code
TYPE=ID MIN=1 MAX=2

Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service


A        Case Turned Over to a Consultant
B        Pre-Admission Testing
C        X-ray or Lab Procedure Related to a Covered Surgery
D        Provider/Supplier determined the service is not covered, but the patient is 
         requesting a formal review by the payor
E        Beneficiary was notified that the item might not be considered medically 
         necessary and has agreed in writing to pay for the item; A signed waiver is on 
         file with the provider
F        Beneficiary was notified that the item might not be considered medically 
         necessary and has not agreed to pay for the item; No signed waiver is on file 
         with the provider
L        Reserved for Local Assignment
N        Reserved for National Assignment