Medical Necessity Validator

Below the CCI Validator is the Medical Necessity Validator, which can also be accessed from the Medical Necessity Validation link located beneath the CCI Validator on the home page and Code Detail pages.

To use the Medical Necessity Validator, first choose whether to show Facility or Non-Facility RVUs. Next, choose your location from the dropdown list. Then, enter single CPT/HCPCS codes in the left boxes and ICD-10-CM codes in the right box. When entering multiple ICD-10-CM codes, separate them by commas or line breaks. If you would like to validate multiple CPT/HCPCS codes against the same ICD-10-CM codes, click the checkbox next to “Repeat ICD-10 code(s) with all CPT/HCPCS codes entered.” To submit additional CPT/HCPCS codes, click the “Add more” button.

The results will be ranked by RVU total, shown in the right column. In the center column, the results will show NCD Validation results, as well as LCD Validation Results for each ICD-10-CM code. If no local coverage policies/articles are found, any appropriate policies/articles for the CPT/HCPCS codes will be linked.

If the CPT/HCPCS code is validated against the ICD-10-CM code, that will be noted and a link to the policy/article will be supplied. The tool may also note if special rules apply for reporting the codes together.

•  relevant.

Watch: Medical Necessity Validator Tutorial