Quick Explanation
Denial code 107 indicates that the submitted claim is missing a necessary reference to a primary, qualifying, or related service that must be identified for the current service to be reimbursed. Payers issue this denial when a billed procedure is dependent on another service—such as an add-on code, an anesthesia service, or a sequential treatment—but the connection to that primary encounter was not established on the claim.
Common Causes for 107
Denials with code 107 typically happen for the following specific reasons:
- Billing an add-on CPT code without reporting the primary parent procedure code on the same claim or referencing its original claim ID.
- Submitting an anesthesia claim without identifying the qualifying primary surgical procedure code in the appropriate field of the CMS-1500 form.
- Failing to link a subsequent or corrected claim to the original claim utilizing the correct Payer Claim Control Number (ICN/DCN) in Loop 2300.
- Reporting dependent secondary procedures or post-operative management services without identifying the qualifying primary surgery date or the initial surgeon.
How to Prevent 107 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Implement electronic claim scrubbing rules that automatically flag dependent or add-on codes billed without their corresponding primary procedures.
- Train billing staff to populate Box 19 or Box 22 on the CMS-1500 (or the corresponding Loop 2300 REF segment on electronic claims) with the qualifying claim's reference number.
- Verify payer-specific policies regarding qualifying circumstances to ensure related claims are submitted concurrently or clearly linked.
- Ensure the original claim reference number (ICN/DCN) is correctly mapped when submitting corrected or split claims.
Appeal Letter Template for 107
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: 107 - The related or qualifying claim/service was not identified on this claim
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code 107: "The related or qualifying claim/service was not identified on this claim".
We are appealing the denial of the billed service, which was denied under code 107 for failing to identify a related or qualifying service. In accordance with AMA CPT guidelines and CMS National Correct Coding Initiative (NCCI) rules, the billed service is a clinically recognized dependent service that directly relates to the primary qualifying procedure [Insert Primary CPT Code], which was performed on [Insert Date of Service] and previously processed under claim number [Insert Primary Claim Number]. The attached medical documentation clearly demonstrates the clinical necessity and relationship between these services, satisfying all billing criteria. We request that this claim be re-evaluated and processed for payment alongside its validated primary qualifying encounter.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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