Claim Rejection - Service Line Procedure Code

Rejection Message

Service line procedure code (HCPCS) is invalid for the patient's age. Code is valid for ages X years – X years. 

Definition

The Procedure Code billed is invalid for the patient's age. Please note that this rejection applies to the patient's age on the Date of Service and not their current age. 

Resolution

A Service Line Procedure Code Rejection based on the Patient's age usually occurs because the specific procedure code is invalid for the patient's age. In order to resolve this please complete the following steps: 

1. Navigate to the Patient's Intake Profile (Patients > Patient Name > Intake > Patient Profile) 
2. Verify that the patient's date of birth was entered correctly 

If the patient's DOB was not entered correctly, it can be edited with the following: 

1. Select Edit in the Patient Profile 
2. Enter the Correct DOB 
3. Click Save 
4. To resubmit the claim, please follow this article: Link to simple created claim article 

If the patient's DOB is correct, we'll need to update the Procedure Code: 

In order to update the procedure code, we'll need to determine if adding a new service, editing the selected service in attendance, or editing the existing service entirely would be the best course of action. 

To add a new service, please see this article: Create a Service and Set Facility Rates

To edit the service selected in Attendance please follow these steps: 

1. Navigate to Attendance on the left 
2. Select the Date for this treatment 
3. Click the "Unlock" button to unsubmit the time 
4. Select the correct Service 
5. Click Submit Treatments for Billing 
6. To resubmit the claim, please follow this article: Link to simple created claim article 

To edit the existing service instead, please follow these steps: 

1. Navigate to the Practice Admin screen 
2. Select the Services tab 
3. Select the service 
4. Select the Billing Profiles tab 
5. Select the billing profile 
6. Select the edit button next to baseline 
7. Verify that the HCPCS used is correct for the patient's age at date of service 
8. To resubmit the claim, please follow this article: Link to simple created claim article