ALJ Appeal Number:
Referral Category:
Medicare Benefit:
<Any>
01-Practitioner Services
03-Acute Inpatient Hospital
04-Office-based Lab/X-Ray
05-Nursing Home
06-Outpatient Therapies / CORF
07-Ground Transportation
08-Home Health
09-Durable Medical Equipment
10-Outpatient Mental Health
11-Hospice
12-Non-Medicare Benefit
13-Prescription Drug
21-Out of Area
24-Skilled Nursing Facility
26-Air Ambulance
30-Pathology/Laboratory
31-Imaging/Radiology
32-Drugs
33-Vision Services
34-Chiropractic
35-Dental
39-AC Dismissal
41-Outpatient Hospital / ASC
42-Acute Inpatient Rehab.
43-Acute Inpatient Psych
44-Outpt Psych/Com Mental Hlth
50-Other
51-Medical/Surgical Supplies
52-Hosp Bed & Support Surfaces
53-Oxygen
54-Manual Wheelchairs
55-Miscellaneous DMEPOS
56-Orthoses
57-Drugs Miscellaneous
58-Enteral/Parenteral Nutri.
59-Glucose Monitors
60-Office E/M Services
61-Hospital E/M Services
62-Facility E/M: SNF/Asst/Home
65-Integum/Musc-skeletal Sur
66-Respiratory/Cardiovsclr Sur
67-Nervous System Surgery
68-Gastro./Urinary/Genital Sur
69-Other Surgery
70-Anesthesia
72-Radiation/Chemo/Infusion
81-Copay/Deductible
82-Eligibility
83-Consolidated Billing
84-Infustion Pumps
85-Power Mobility Devices
87-Prostheses
88-Ostomy & Urological
89-Pos. Airway Pressure Device
90-Neg. Pressure Wound Therapy
91-Pneumatic compressor
93-Respiratory-Miscellaneous
94-Surgical Dressings
AC Dismissal
Acute Hospital
Chiropractic
Clinic/Lab/X-Ray
Dental
DME
Emergency Room
Home Health/Hospice
Medical Supplies
Non-MD Practitioner
Other
Outpatient Mental Health
Outpatient Therapies
Practitioner Services
Prescription Drug
Prosthetics/Orthotics
QIC Dismissal
Skilled Nursing Facility
Transportation
Vision Care
<Any>
B North
DME
Part A
Part B
*
Appellant:
Procedure Code:
Rationale:
Show Associated Appeals
AdQIC Referral Date
From
To
Appeals Council Decision Date
From
To
Appeals Council Disposition:
<Any>
Dismissed
Favorable
Partially Favorable
Remand Dismissed
Remanded
Unfavorable
Vacated
Withdrawn
*If the appellant is a beneficiary, search by the term "beneficiary" in the Appellant field above. Referrals are not searchable by specific beneficiaries.