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Edit 00710
Procedure/Formulary Code Exceeds Service Limits
HIPAA Claim Adjustment Reason Code: 150
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 121
Entity Identifier Code: N/A
Potential Causes:
There are different service limits for different procedure codes. Service limits are set for how often a procedure may be performed over a period of time. This claim exceeds the limits set for this procedure.
Solution:
Please check to be sure that you are billing with the appropriate procedure code. If you are billing with an incorrect procedure code, please correct the procedure code and resubmit. The procedure code can be found in the following loop and segments.
| 837 Institutional |
Loop 2400, SV2 (Institutional Service Line) - (Non-Inpatient)
SV202-1 = HC (Product/Service ID Qualifier)
SV202-2 = Procedure Code – Enter HCPCS procedure code (Product/Service ID) |
| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
| 837 Dental |
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID) |
Note: If you are billing with the correct procedure code and need further assistance, please see “Contact Us” in the announcement section of this website. (www.nyhipaadesk.com)
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