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