N762Remark Code (RARC)Active
N762 Remark Code - Facility Not Certified for Tomosynthesis
The N762 remark code indicates that the facility where the mammography service was provided is not certified to perform Tomosynthesis (3-D) mammography. This remark supplements an adjustment already specified by an accompanying reason code, clarifying the reason for the denial or adjustment related to the mammography claim.
How It Relates to the Denial
The N762 remark code typically accompanies a claim adjustment reason code that indicates a service denial, specifically for procedures that require certification. This combination signals that the claim was denied due to the facility's lack of the necessary certification for providing Tomosynthesis mammography services.
Common Scenarios
1A claim was submitted for a Tomosynthesis mammogram performed at a facility that does not have the required certification. Upon processing, the claim was denied with an adjustment reason code related to certification issues.
→ In this scenario, the N762 remark code clarifies that the denial is specifically because the facility is not certified for the Tomosynthesis procedure, confirming the adjustment reason.
2A patient received a 3-D mammogram at a clinic, and the claim was returned with a denial indicating the service was not covered. The remittance included the N762 remark code.
→ Here, the N762 remark code points to the certification issue of the facility, reinforcing that the service provided is not eligible for reimbursement due to lack of certification.
3A billing office received a remittance for a claim involving Tomosynthesis mammography, which was adjusted due to a lack of facility certification. The N762 remark appeared on the remittance advice.
→ This indicates that the adjustment is directly tied to the facility's inability to offer Tomosynthesis mammography services, as explained by the N762 remark.
What to Do
- Verify the certification status of the facility for Tomosynthesis mammography.
- If the facility is not certified, consider alternative options for billing or resubmitting the claim with a certified provider.
- Communicate with the patient about the denial and possible next steps for receiving the service at a certified facility.
What to Check
- The facility's certification documentation related to Tomosynthesis mammography.
- The claim submission details to confirm the service type billed.
- The accompanying claim adjustment reason code on the remittance advice for additional context.