I’ve recently had some Medicare denials for new patient office visits and I need some help on figuring out why. One example: the dx’s the physician linked to the CPT code were Z76.89 (Persons encountering health services in other specified circumstances, Z79.891 – Long term (current) use of opiate analgesic, and then a couple others relating to his health status, like blood pressure, etc.

The Reason code on the EOB is "PR-49 This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam."

The physician tends to use that Z76.89 Dx code as first listed for our new patient appointments. However, I did have another denial where that was not used so I’m unsure that the Dx code is the issue. The reason code of the denials I’ve received have all been that PR-49 code. Help! I appreciate it so much.