Remark code N87 indicates that biofeedback therapy for home use is not covered by the patient's insurance plan.
Remark code N87 indicates that the claim submitted for biofeedback therapy intended for home use has been denied because the payer does not provide coverage for this service when used outside of a professional healthcare setting.
Common causes of code N87 are:
1. The claim was submitted for biofeedback therapy services intended for home use.
2. The patient's insurance policy does not include coverage for biofeedback therapy when used in a home setting.
3. The provider did not obtain prior authorization for home biofeedback therapy, which is a requirement for coverage under the patient's insurance plan.
4. The claim was incorrectly coded as home biofeedback therapy instead of an in-office procedure, which may be covered.
5. There is a lack of medical necessity documentation to support the use of biofeedback therapy at home.
6. The insurance plan may only cover biofeedback therapy for certain diagnoses or conditions, which do not match the patient's medical records.
7. The billing staff may have used an outdated or incorrect code that does not align with current insurance policy guidelines for biofeedback therapy.
Ways to mitigate code N87 include ensuring that biofeedback therapy is provided in an approved setting, such as a physician's office or a clinical environment, rather than at the patient's home. It's important to verify coverage for biofeedback therapy with the patient's insurance plan before scheduling the treatment. Additionally, educating staff on the specific requirements and limitations of biofeedback therapy coverage can help prevent this denial. Proper documentation demonstrating medical necessity and adherence to the insurer's guidelines for biofeedback therapy is also crucial. If home use is essential for the patient's treatment, consider reaching out to the insurer to discuss possible exceptions or alternative therapies that are covered for home use.
The steps to address code N87 involve reviewing the patient's medical records to ensure that the biofeedback therapy was indeed prescribed for home use. If the therapy was intended for an in-office setting, resubmit the claim with the correct place of service code. If the therapy was for home use, check the patient's insurance plan benefits to determine if there is an exclusion for this type of therapy. If an exclusion exists, inform the patient of their financial responsibility. If the therapy should be covered, appeal the denial with supporting documentation, such as a letter of medical necessity from the prescribing provider, outlining the clinical reasons why home biofeedback therapy is essential for the patient's condition.
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