202Denial Code (CARC)Active
PR 202 Denial Code: Fix Non-Covered Services
Code 202 indicates that the denied services are considered non-covered because they are for personal comfort or convenience. This means the payer has determined the service does not meet the criteria for medical necessity and is not a covered benefit under the patient's policy.
Who Pays: Group Code Liability
For code 202, the group code PR applies, making the denied amount the patient's responsibility. The provider can bill the patient for these services since they are deemed non-covered.
Why Claims Get Code 202
- The service provided is a personal comfort item, such as a television rental in a hospital room.
- The procedure was for patient convenience, like an extra meal not medically necessary.
- The payer's policy explicitly excludes the service as non-covered.
- The service was incorrectly coded as medically necessary when it is classified as personal comfort.
- The denial occurred because the service was not documented as medically necessary in the patient's records.
How to Fix & Resubmit
- Review the patient's insurance policy to confirm that the service is indeed non-covered.
- Check the medical records to ensure the service was not incorrectly coded as a personal comfort item.
- Verify that the documentation supports medical necessity if the service should be covered.
- If documentation supports coverage, contact the payer for clarification or submit a corrected claim with additional documentation.
- If the service is non-covered, bill the patient for the denied amount.
Corrected Claim or Appeal?
Submit a corrected claim if documentation proves the service is medically necessary. Appeal if the payer's policy or application of the policy seems incorrect. Bill the patient if the service is truly non-covered.
Preventing Future 202 Denials
- Ensure coding is accurate and reflects medically necessary services.
- Educate staff on identifying services that are non-covered under common payer policies.
- Regularly update billing staff on payer policy changes regarding covered services.
- Implement a pre-service check for non-covered services to inform patients upfront.