CARC 49: These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam
Your insurer is treating this service as part of a routine exam rather than a medically necessary visit.
What this means for your claim
Preventive/routine services and medically necessary services are billed differently. If a routine check-up includes a problem-focused exam, the additional service may be denied as 'routine' unless billed with the correct modifiers.
What to do next
- 1
Ask your provider if a modifier (such as Modifier 25) was included to indicate a separately identifiable service was performed.
- 2
If you had a genuine medical problem addressed during a wellness visit, the evaluation and management code should be separately billable.
- 3
Request the provider appeal or refile with correct coding to distinguish the preventive from the problem-focused service.
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