Xray or Lab Procedure Related to a Covered Surgery
D
Provider/Supplier determined the service is not covered, but the patient is requesting a formal review by the payor
E
Beneficiary was notified that the item might not be considered medically necessary and has agreed in writing to pay for the item; A signed waiver is on file with the provider
F
Beneficiary was notified that the item might not be considered medically necessary and has not agreed to pay for the item; No signed waiver is on file with the provider