Medical Necessity Validator

Using the Medical Necessity Validator

The Medical Necessity Validator is located directly below the CCI Validator. You can also access it via the Medical Necessity Validation link found on the home page and Code Detail pages.

Steps to Use the Validator:

1. Select whether to display Facility or Non-Facility RVUs.
2. Choose your location from the dropdown list.
3. Enter:
   • Single CPT/HCPCS codes in the left boxes
   • ICD-10-CM codes in the right box
4. If entering multiple ICD-10-CM codes, separate them by commas or line breaks.
5. To validate multiple CPT/HCPCS codes against the same ICD-10-CM codes, check the box labeled "Repeat ICD-10 code(s) with all CPT/HCPCS codes entered."
6. Click the Add more button to include additional CPT/HCPCS codes.

Interpreting the Results

• RVU totals are displayed in the right column.
• The center columnshows:
  • NCD Validation results
  • LCD Validation results per ICD-10-CM code
• If no local coverage policies/articles are found, related policies/articles tied to the CPT/HCPCS code may still be linked.
• Validation status and links to relevant policies or articles will be provided when applicable.
• Special reporting rules may also be flagged by the tool when relevant.

Watch: Medical Necessity Validator Tutorial