Reason Code 5H920: The Recommended Protocol Was Not Ordered and/or Followed

Reason for the Denial
Medicare cannot pay for this service because one or more requirements for coverage were not met.

To Prevent This Denial
Documentation that may be helpful to avoid future denials for this reason may include, but are not limited to, the following:

• Clear physician’s order with indication of need, dose, frequency and route
• Date and time of associated chemotherapy, as applicable
• Relevant history and physical and/or progress notes
  • Clear indication of the diagnosis
  • Clinical signs and symptoms
  • Prior treatment and response as applicable
  • Stage of treatment as applicable
• Documentation of administration

For more information on the above Medicare coverage issue, references include, but are not limited to, these resources:

• CMS Internet-Only Manuals (IOMs), Medicare Benefit Policy Manual, Publication 100-02, Chapter 15, Section 50 (PDF, 1.28 MB)
• CMS Internet-Only Manuals (IOMs), Medicare Claims Processing Manual, Publication 100-04, Chapter 17 (PDF, 538 KB)