PGBA denial, reaon code 50 (Part B)
We received a denial of a Part B therapy claim. Reason code 50 - medical necessity.
All 97535 OT codes were denied.
The UB-04 shows a -59 modifier on most OT 97535 codes (because PT performed 97530 on those same dates of service). There are a few without the -59 because there was no column 1 code such as 97530 billed that same day.
The LCD shows that the ICD-10 codes we used were supportive of medical necessity. We used R26.2, Z91.81, M62.81.
We cannot figure out what went wrong. They also tell us that this is not appealable. So it's just a denial with no clear understnading of what went wrong or what steps we should next take. The denial came up in TruBridge and and in FISS. line item denial reason 55503.
Any thoughts? Anyone seen this?