1364 Review Code

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

Type

Identifier (ID)

Length

Min 1 / Max 2

Codes

Code	Description
A	Case Turned Over to a Consultant
B	Pre-Admission Testing
C	Xray 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