Claim Adjustment Reason Codes - All

Claim adjustment reason codes communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.

Last Update: 7/1/2009

1	Deductible Amount Start: 01/01/1995
2	Coinsurance Amount Start: 01/01/1995
3	Co-payment Amount Start: 01/01/1995
4	The procedure code is inconsistent with the modifier used or a required modifier is missing. Start: 01/01/1995
5	The procedure code/bill type is inconsistent with the place of service. Start: 01/01/1995
6	The procedure/revenue code is inconsistent with the patient's age. Start: 01/01/1995 \| Last Modified: 06/30/2002
7	The procedure/revenue code is inconsistent with the patient's gender. Start: 01/01/1995 \| Last Modified: 06/30/2002
8	The procedure code is inconsistent with the provider type/specialty (taxonomy). Start: 01/01/1995 \| Last Modified: 06/30/2002
9	The diagnosis is inconsistent with the patient's age. Start: 01/01/1995
10	The diagnosis is inconsistent with the patient's gender. Start: 01/01/1995 \| Last Modified: 02/29/2000
11	The diagnosis is inconsistent with the procedure. Start: 01/01/1995
12	The diagnosis is inconsistent with the provider type. Start: 01/01/1995
13	The date of death precedes the date of service. Start: 01/01/1995
14	The date of birth follows the date of service. Start: 01/01/1995
15	The authorization number is missing, invalid, or does not apply to the billed services or provider. Start: 01/01/1995 \| Last Modified: 09/30/2007
16	Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 06/30/2006
17	Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 09/21/2008 \| Stop: 07/01/2009
18	Duplicate claim/service. Start: 01/01/1995
19	This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007
20	This injury/illness is covered by the liability carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007
21	This injury/illness is the liability of the no-fault carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007
22	This care may be covered by another payer per coordination of benefits. Start: 01/01/1995 \| Last Modified: 09/30/2007
23	The impact of prior payer(s) adjudication including payments and/or adjustments. Start: 01/01/1995 \| Last Modified: 09/30/2007
24	Charges are covered under a capitation agreement/managed care plan. Start: 01/01/1995 \| Last Modified: 09/30/2007
25	Payment denied. Your Stop loss deductible has not been met. Start: 01/01/1995 \| Stop: 04/01/2008
26	Expenses incurred prior to coverage. Start: 01/01/1995
27	Expenses incurred after coverage terminated. Start: 01/01/1995
28	Coverage not in effect at the time the service was provided. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Redundant to codes 26&27.
29	The time limit for filing has expired. Start: 01/01/1995
30	Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Start: 01/01/1995 \| Stop: 02/01/2006
31	Patient cannot be identified as our insured. Start: 01/01/1995 \| Last Modified: 09/30/2007
32	Our records indicate that this dependent is not an eligible dependent as defined. Start: 01/01/1995
33	Insured has no dependent coverage. Start: 01/01/1995 \| Last Modified: 09/30/2007
34	Insured has no coverage for newborns. Start: 01/01/1995 \| Last Modified: 09/30/2007
35	Lifetime benefit maximum has been reached. Start: 01/01/1995 \| Last Modified: 10/31/2002
36	Balance does not exceed co-payment amount. Start: 01/01/1995 \| Stop: 10/16/2003
37	Balance does not exceed deductible. Start: 01/01/1995 \| Stop: 10/16/2003
38	Services not provided or authorized by designated (network/primary care) providers. Start: 01/01/1995 \| Last Modified: 06/30/2003
39	Services denied at the time authorization/pre-certification was requested. Start: 01/01/1995
40	Charges do not meet qualifications for emergent/urgent care. This change to be effective 04/01/2010: Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
41	Discount agreed to in Preferred Provider contract. Start: 01/01/1995 \| Stop: 10/16/2003
42	Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45) Start: 01/01/1995 \| Last Modified: 10/31/2006 \| Stop: 06/01/2007
43	Gramm-Rudman reduction. Start: 01/01/1995 \| Stop: 07/01/2006
44	Prompt-pay discount. Start: 01/01/1995
45	Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). Start: 01/01/1995 \| Last Modified: 10/31/2006
46	This (these) service(s) is (are) not covered. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 96.
47	This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Start: 01/01/1995 \| Stop: 02/01/2006
48	This (these) procedure(s) is (are) not covered. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 96.
49	These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. Start: 01/01/1995
50	These are non-covered services because this is not deemed a 'medical necessity' by the payer. This change to be effective 04/01/2010: These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
51	These are non-covered services because this is a pre-existing condition Start: 01/01/1995
52	The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. Start: 01/01/1995 \| Stop: 02/01/2006
53	Services by an immediate relative or a member of the same household are not covered. Start: 01/01/1995
54	Multiple physicians/assistants are not covered in this case. This change to be effective 04/01/2010: Multiple physicians/assistants are not covered in this case. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
55	Procedure/treatment is deemed experimental/investigational by the payer. This change to be effective 04/01/2010: Procedure/treatment is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
56	Procedure/treatment has not been deemed 'proven to be effective' by the payer. This change to be effective 04/01/2010: Procedure/treatment has not been deemed `proven to be effective' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
57	Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Split into codes 150, 151, 152, 153 and 154.
58	Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. This change to be effective 04/01/2010: Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
59	Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) This change to be effective 04/01/2010: Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
60	Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services. Start: 01/01/1995 \| Last Modified: 06/01/2008
61	Penalty for failure to obtain second surgical opinion. Start: 01/01/1995 \| Last Modified: 09/30/2007
62	Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. Start: 01/01/1995 \| Last Modified: 10/31/2006 \| Stop: 04/01/2007
63	Correction to a prior claim. Start: 01/01/1995 \| Stop: 10/16/2003
64	Denial reversed per Medical Review. Start: 01/01/1995 \| Stop: 10/16/2003
65	Procedure code was incorrect. This payment reflects the correct code. Start: 01/01/1995 \| Stop: 10/16/2003
66	Blood Deductible. Start: 01/01/1995
67	Lifetime reserve days. (Handled in QTY, QTY01=LA) Start: 01/01/1995 \| Stop: 10/16/2003
68	DRG weight. (Handled in CLP12) Start: 01/01/1995 \| Stop: 10/16/2003
69	Day outlier amount. Start: 01/01/1995
70	Cost outlier - Adjustment to compensate for additional costs. Start: 01/01/1995 \| Last Modified: 06/30/2001
71	Primary Payer amount. Start: 01/01/1995 \| Stop: 06/30/2000 Notes: Use code 23.
72	Coinsurance day. (Handled in QTY, QTY01=CD) Start: 01/01/1995 \| Stop: 10/16/2003
73	Administrative days. Start: 01/01/1995 \| Stop: 10/16/2003
74	Indirect Medical Education Adjustment. Start: 01/01/1995
75	Direct Medical Education Adjustment. Start: 01/01/1995
76	Disproportionate Share Adjustment. Start: 01/01/1995
77	Covered days. (Handled in QTY, QTY01=CA) Start: 01/01/1995 \| Stop: 10/16/2003
78	Non-Covered days/Room charge adjustment. Start: 01/01/1995
79	Cost Report days. (Handled in MIA15) Start: 01/01/1995 \| Stop: 10/16/2003
80	Outlier days. (Handled in QTY, QTY01=OU) Start: 01/01/1995 \| Stop: 10/16/2003
81	Discharges. Start: 01/01/1995 \| Stop: 10/16/2003
82	PIP days. Start: 01/01/1995 \| Stop: 10/16/2003
83	Total visits. Start: 01/01/1995 \| Stop: 10/16/2003
84	Capital Adjustment. (Handled in MIA) Start: 01/01/1995 \| Stop: 10/16/2003
85	Patient Interest Adjustment (Use Only Group code PR) Start: 01/01/1995 \| Last Modified: 07/09/2007 Notes: Only use when the payment of interest is the responsibility of the patient.
86	Statutory Adjustment. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Duplicative of code 45.
87	Transfer amount. Start: 01/01/1995
88	Adjustment amount represents collection against receivable created in prior overpayment. Start: 01/01/1995 \| Stop: 06/30/2007
89	Professional fees removed from charges. Start: 01/01/1995
90	Ingredient cost adjustment. This change to be effective 04/01/2010: Ingredient cost adjustment. Note: To be used for pharmaceuticals only. Start: 01/01/1995 \| Last Modified: 07/01/2009
91	Dispensing fee adjustment. Start: 01/01/1995
92	Claim Paid in full. Start: 01/01/1995 \| Stop: 10/16/2003
93	No Claim level Adjustments. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: As of 004010, CAS at the claim level is optional.
94	Processed in Excess of charges. Start: 01/01/1995
95	Plan procedures not followed. Start: 01/01/1995 \| Last Modified: 09/30/2007
96	Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 06/30/2006
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Start: 01/01/1995 \| Last Modified: 09/30/2007
98	The hospital must file the Medicare claim for this inpatient non-physician service. Start: 01/01/1995 \| Stop: 10/16/2003
99	Medicare Secondary Payer Adjustment Amount. Start: 01/01/1995 \| Stop: 10/16/2003
100	Payment made to patient/insured/responsible party/employer. Start: 01/01/1995 \| Last Modified: 01/27/2008
101	Predetermination: anticipated payment upon completion of services or claim adjudication. Start: 01/01/1995 \| Last Modified: 02/28/1999
102	Major Medical Adjustment. Start: 01/01/1995
103	Provider promotional discount (e.g., Senior citizen discount). Start: 01/01/1995 \| Last Modified: 06/30/2001
104	Managed care withholding. Start: 01/01/1995
105	Tax withholding. Start: 01/01/1995
106	Patient payment option/election not in effect. Start: 01/01/1995
107	The related or qualifying claim/service was not identified on this claim. Start: 01/01/1995 \| Last Modified: 09/30/2007
108	Rent/purchase guidelines were not met. Start: 01/01/1995 \| Last Modified: 09/30/2007
109	Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. Start: 01/01/1995
110	Billing date predates service date. Start: 01/01/1995
111	Not covered unless the provider accepts assignment. Start: 01/01/1995
112	Service not furnished directly to the patient and/or not documented. Start: 01/01/1995 \| Last Modified: 09/30/2007
113	Payment denied because service/procedure was provided outside the United States or as a result of war. Start: 01/01/1995 \| Last Modified: 02/28/2001 \| Stop: 06/30/2007 Notes: Use Codes 157, 158 or 159.
114	Procedure/product not approved by the Food and Drug Administration. Start: 01/01/1995
115	Procedure postponed, canceled, or delayed. Start: 01/01/1995 \| Last Modified: 09/30/2007
116	The advance indemnification notice signed by the patient did not comply with requirements. Start: 01/01/1995 \| Last Modified: 09/30/2007
117	Transportation is only covered to the closest facility that can provide the necessary care. Start: 01/01/1995 \| Last Modified: 09/30/2007
118	ESRD network support adjustment. Start: 01/01/1995 \| Last Modified: 09/30/2007
119	Benefit maximum for this time period or occurrence has been reached. Start: 01/01/1995 \| Last Modified: 02/29/2004
120	Patient is covered by a managed care plan. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Use code 24.
121	Indemnification adjustment - compensation for outstanding member responsibility. Start: 01/01/1995 \| Last Modified: 09/30/2007
122	Psychiatric reduction. Start: 01/01/1995
123	Payer refund due to overpayment. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals.
124	Payer refund amount - not our patient. Start: 01/01/1995 \| Last Modified: 06/30/1999 \| Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals.
125	Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 09/30/2007
126	Deductible -- Major Medical Start: 02/28/1997 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008 Notes: Use Group Code PR and code 1.
127	Coinsurance -- Major Medical Start: 02/28/1997 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008 Notes: Use Group Code PR and code 2.
128	Newborn's services are covered in the mother's Allowance. Start: 02/28/1997
129	Prior processing information appears incorrect. Start: 02/28/1997 \| Last Modified: 09/30/2007
130	Claim submission fee. Start: 02/28/1997 \| Last Modified: 06/30/2001
131	Claim specific negotiated discount. Start: 02/28/1997
132	Prearranged demonstration project adjustment. Start: 02/28/1997
133	The disposition of this claim/service is pending further review. Start: 02/28/1997 \| Last Modified: 10/31/1999
134	Technical fees removed from charges. Start: 10/31/1998
135	Interim bills cannot be processed. Start: 10/31/1998 \| Last Modified: 09/30/2007
136	Failure to follow prior payer's coverage rules. (Use Group Code OA). Start: 10/31/1998 \| Last Modified: 09/30/2007
137	Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Start: 02/28/1999 \| Last Modified: 09/30/2007
138	Appeal procedures not followed or time limits not met. Start: 06/30/1999 \| Last Modified: 09/30/2007
139	Contracted funding agreement - Subscriber is employed by the provider of services. Start: 06/30/1999
140	Patient/Insured health identification number and name do not match. Start: 06/30/1999
141	Claim spans eligible and ineligible periods of coverage. Start: 06/30/1999 \| Last Modified: 09/30/2007
142	Monthly Medicaid patient liability amount. Start: 06/30/2000 \| Last Modified: 09/30/2007
143	Portion of payment deferred. Start: 02/28/2001
144	Incentive adjustment, e.g. preferred product/service. Start: 06/30/2001
145	Premium payment withholding Start: 06/30/2002 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008 Notes: Use Group Code CO and code 45.
146	Diagnosis was invalid for the date(s) of service reported. Start: 06/30/2002 \| Last Modified: 09/30/2007
147	Provider contracted/negotiated rate expired or not on file. Start: 06/30/2002
148	Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 06/30/2002 \| Last Modified: 09/21/2008
149	Lifetime benefit maximum has been reached for this service/benefit category. Start: 10/31/2002
150	Payer deems the information submitted does not support this level of service. Start: 10/31/2002 \| Last Modified: 09/30/2007
151	Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. Start: 10/31/2002 \| Last Modified: 01/27/2008
152	Payer deems the information submitted does not support this length of service. Start: 10/31/2002 \| Last Modified: 09/30/2007
153	Payer deems the information submitted does not support this dosage. Start: 10/31/2002 \| Last Modified: 09/30/2007
154	Payer deems the information submitted does not support this day's supply. Start: 10/31/2002 \| Last Modified: 09/30/2007
155	Patient refused the service/procedure. Start: 06/30/2003 \| Last Modified: 09/30/2007
156	Flexible spending account payments. Note: Use code 187. Start: 09/30/2003 \| Last Modified: 01/25/2009 \| Stop: 10/01/2009
157	Service/procedure was provided as a result of an act of war. Start: 09/30/2003 \| Last Modified: 09/30/2007
158	Service/procedure was provided outside of the United States. Start: 09/30/2003 \| Last Modified: 09/30/2007
159	Service/procedure was provided as a result of terrorism. Start: 09/30/2003 \| Last Modified: 09/30/2007
160	Injury/illness was the result of an activity that is a benefit exclusion. Start: 09/30/2003 \| Last Modified: 09/30/2007
161	Provider performance bonus Start: 02/29/2004
162	State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Start: 02/29/2004
163	Attachment referenced on the claim was not received. Start: 06/30/2004 \| Last Modified: 09/30/2007
164	Attachment referenced on the claim was not received in a timely fashion. Start: 06/30/2004 \| Last Modified: 09/30/2007
165	Referral absent or exceeded. Start: 10/31/2004 \| Last Modified: 09/30/2007
166	These services were submitted after this payers responsibility for processing claims under this plan ended. Start: 02/28/2005
167	This (these) diagnosis(es) is (are) not covered. Start: 06/30/2005
168	Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan. Start: 06/30/2005 \| Last Modified: 09/30/2007
169	Alternate benefit has been provided. Start: 06/30/2005 \| Last Modified: 09/30/2007
170	Payment is denied when performed/billed by this type of provider. Start: 06/30/2005
171	Payment is denied when performed/billed by this type of provider in this type of facility. Start: 06/30/2005
172	Payment is adjusted when performed/billed by a provider of this specialty Start: 06/30/2005
173	Service was not prescribed by a physician. Start: 06/30/2005 \| Last Modified: 09/30/2007
174	Service was not prescribed prior to delivery. Start: 06/30/2005 \| Last Modified: 09/30/2007
175	Prescription is incomplete. Start: 06/30/2005 \| Last Modified: 09/30/2007
176	Prescription is not current. Start: 06/30/2005 \| Last Modified: 09/30/2007
177	Patient has not met the required eligibility requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
178	Patient has not met the required spend down requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
179	Patient has not met the required waiting requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
180	Patient has not met the required residency requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
181	Procedure code was invalid on the date of service. Start: 06/30/2005 \| Last Modified: 09/30/2007
182	Procedure modifier was invalid on the date of service. Start: 06/30/2005 \| Last Modified: 09/30/2007
183	The referring provider is not eligible to refer the service billed. Start: 06/30/2005
184	The prescribing/ordering provider is not eligible to prescribe/order the service billed. Start: 06/30/2005
185	The rendering provider is not eligible to perform the service billed. Start: 06/30/2005
186	Level of care change adjustment. Start: 06/30/2005 \| Last Modified: 09/30/2007
187	Health Savings account payments. This change to be effective 10/1/2009: Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.) Start: 06/30/2005 \| Last Modified: 01/25/2009
188	This product/procedure is only covered when used according to FDA recommendations. Start: 06/30/2005
189	'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service Start: 06/30/2005
190	Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Start: 10/31/2005
191	Not a work related injury/illness and thus not the liability of the workers' compensation carrier. Start: 10/31/2005 \| Last Modified: 09/30/2007
192	Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. Start: 10/31/2005 \| Last Modified: 09/30/2007
193	Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly. Start: 02/28/2006 \| Last Modified: 01/27/2008
194	Anesthesia performed by the operating physician, the assistant surgeon or the attending physician. Start: 02/28/2006 \| Last Modified: 09/30/2007
195	Refund issued to an erroneous priority payer for this claim/service. Start: 02/28/2006 \| Last Modified: 09/30/2007
196	Claim/service denied based on prior payer's coverage determination. Start: 06/30/2006 \| Stop: 02/01/2007 Notes: Use code 136.
197	Precertification/authorization/notification absent. Start: 10/31/2006 \| Last Modified: 09/30/2007
198	Precertification/authorization exceeded. Start: 10/31/2006 \| Last Modified: 09/30/2007
199	Revenue code and Procedure code do not match. Start: 10/31/2006
200	Expenses incurred during lapse in coverage Start: 10/31/2006
201	Workers Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. (Use group code PR). Start: 10/31/2006
202	Non-covered personal comfort or convenience services. Start: 02/28/2007 \| Last Modified: 09/30/2007
203	Discontinued or reduced service. Start: 02/28/2007 \| Last Modified: 09/30/2007
204	This service/equipment/drug is not covered under the patient's current benefit plan Start: 02/28/2007
205	Pharmacy discount card processing fee Start: 07/09/2007
206	National Provider Identifier - missing. Start: 07/09/2007 \| Last Modified: 09/30/2007
207	National Provider identifier - Invalid format Start: 07/09/2007 \| Last Modified: 06/01/2008
208	National Provider Identifier - Not matched. Start: 07/09/2007 \| Last Modified: 09/30/2007
209	Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use Group code OA) Start: 07/09/2007
210	Payment adjusted because pre-certification/authorization not received in a timely fashion Start: 07/09/2007
211	National Drug Codes (NDC) not eligible for rebate, are not covered. Start: 07/09/2007
212	Administrative surcharges are not covered Start: 11/05/2007
213	Non-compliance with the physician self referral prohibition legislation or payer policy. Start: 01/27/2008
214	Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. (Note: To be used for Workers' Compensation only) Start: 01/27/2008
215	Based on subrogation of a third party settlement Start: 01/27/2008
216	Based on the findings of a review organization Start: 01/27/2008
217	Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. (Note: To be used for Workers' Compensation only) Start: 01/27/2008
218	Based on entitlement to benefits (Note: To be used for Workers' Compensation only) Start: 01/27/2008
219	Based on extent of injury (Note: To be used for Workers' Compensation only) Start: 01/27/2008
220	The applicable fee schedule does not contain the billed code. Please resubmit a bill with the appropriate fee schedule code(s) that best describe the service(s) provided and supporting documentation if required. (Note: To be used for Workers' Compensation only) Start: 01/27/2008
221	Workers' Compensation claim is under investigation. (Note: To be used for Workers' Compensation only. Claim pending final resolution) Start: 01/27/2008
222	Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Start: 06/01/2008
223	Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. Start: 06/01/2008
224	Patient identification compromised by identity theft. Identity verification required for processing this and future claims. Start: 06/01/2008
225	Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837) Start: 06/01/2008
226	Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 09/21/2008
227	Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 09/21/2008
228	Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication Start: 09/21/2008
229	Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. Use Group Code PR. Start: 01/25/2009
230	No available or correlating CPT/HCPCS code to describe this service. Note: Used only by Property and Casualty. Start: 01/25/2009
231	Mutually exclusive procedures cannot be done in the same day/setting. Start: 01/01/2010 Notes: Refer to the 835 Healthcare Policy Identification Segment, if present
A0	Patient refund amount. Start: 01/01/1995
A1	Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 10/31/2006
A2	Contractual adjustment. Start: 01/01/1995 \| Last Modified: 02/28/2007 \| Stop: 01/01/2008 Notes: Use Code 45 with Group Code 'CO' or use another appropriate specific adjustment code.
A3	Medicare Secondary Payer liability met. Start: 01/01/1995 \| Stop: 10/16/2003
A4	Medicare Claim PPS Capital Day Outlier Amount. Start: 01/01/1995 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008
A5	Medicare Claim PPS Capital Cost Outlier Amount. Start: 01/01/1995
A6	Prior hospitalization or 30 day transfer requirement not met. Start: 01/01/1995
A7	Presumptive Payment Adjustment Start: 01/01/1995
A8	Ungroupable DRG. Start: 01/01/1995 \| Last Modified: 09/30/2007
B1	Non-covered visits. Start: 01/01/1995
B2	Covered visits. Start: 01/01/1995 \| Stop: 10/16/2003
B3	Covered charges. Start: 01/01/1995 \| Stop: 10/16/2003
B4	Late filing penalty. Start: 01/01/1995
B5	Coverage/program guidelines were not met or were exceeded. Start: 01/01/1995 \| Last Modified: 09/30/2007
B6	This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. Start: 01/01/1995 \| Stop: 02/01/2006
B7	This provider was not certified/eligible to be paid for this procedure/service on this date of service. Start: 01/01/1995 \| Last Modified: 10/31/1998
B8	Alternative services were available, and should have been utilized. Start: 01/01/1995 \| Last Modified: 09/30/2007
B9	Patient is enrolled in a Hospice. Start: 01/01/1995 \| Last Modified: 09/30/2007
B10	Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test. Start: 01/01/1995
B11	The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. Start: 01/01/1995
B12	Services not documented in patients' medical records. Start: 01/01/1995
B13	Previously paid. Payment for this claim/service may have been provided in a previous payment. Start: 01/01/1995
B14	Only one visit or consultation per physician per day is covered. Start: 01/01/1995 \| Last Modified: 09/30/2007
B15	This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Start: 01/01/1995 \| Last Modified: 09/30/2007
B16	'New Patient' qualifications were not met. Start: 01/01/1995 \| Last Modified: 09/30/2007
B17	Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current. Start: 01/01/1995 \| Stop: 02/01/2006
B18	This procedure code and modifier were invalid on the date of service. Start: 01/01/1995 \| Last Modified: 09/21/2008 \| Stop: 03/01/2009
B19	Claim/service adjusted because of the finding of a Review Organization. Start: 01/01/1995 \| Stop: 10/16/2003
B20	Procedure/service was partially or fully furnished by another provider. Start: 01/01/1995 \| Last Modified: 09/30/2007
B21	The charges were reduced because the service/care was partially furnished by another physician. Start: 01/01/1995 \| Stop: 10/16/2003
B22	This payment is adjusted based on the diagnosis. Start: 01/01/1995 \| Last Modified: 02/28/2001
B23	Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Start: 01/01/1995 \| Last Modified: 09/30/2007
D1	Claim/service denied. Level of subluxation is missing or inadequate. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D2	Claim lacks the name, strength, or dosage of the drug furnished. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D3	Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D4	Claim/service does not indicate the period of time for which this will be needed. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D5	Claim/service denied. Claim lacks individual lab codes included in the test. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D6	Claim/service denied. Claim did not include patient's medical record for the service. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D7	Claim/service denied. Claim lacks date of patient's most recent physician visit. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D8	Claim/service denied. Claim lacks indicator that 'x-ray is available for review.' Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D9	Claim/service denied. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D10	Claim/service denied. Completed physician financial relationship form not on file. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D11	Claim lacks completed pacemaker registration form. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D12	Claim/service denied. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D13	Claim/service denied. Performed by a facility/supplier in which the ordering/referring physician has a financial interest. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D14	Claim lacks indication that plan of treatment is on file. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D15	Claim lacks indication that service was supervised or evaluated by a physician. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D16	Claim lacks prior payer payment information. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code [N4].
D17	Claim/Service has invalid non-covered days. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code.
D18	Claim/Service has missing diagnosis information. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code.
D19	Claim/Service lacks Physician/Operative or other supporting documentation Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code.
D20	Claim/Service missing service/product information. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code.
D21	This (these) diagnosis(es) is (are) missing or are invalid Start: 01/01/1995 \| Stop: 06/30/2007
D22	Reimbursement was adjusted for the reasons to be provided in separate correspondence. (Note: To be used for Workers' Compensation only) - Temporary code to be added for timeframe only until 01/01/2009. Another code to be established and/or for 06/2008 meeting for a revised code to replace or strategy to use another existing code Start: 01/27/2008 \| Stop: 01/01/2009
W1	Workers Compensation State Fee Schedule Adjustment Start: 02/29/2000
1	Deductible Amount Start: 01/01/1995
2	Coinsurance Amount Start: 01/01/1995
3	Co-payment Amount Start: 01/01/1995
4	The procedure code is inconsistent with the modifier used or a required modifier is missing. Start: 01/01/1995
5	The procedure code/bill type is inconsistent with the place of service. Start: 01/01/1995
6	The procedure/revenue code is inconsistent with the patient's age. Start: 01/01/1995 \| Last Modified: 06/30/2002
7	The procedure/revenue code is inconsistent with the patient's gender. Start: 01/01/1995 \| Last Modified: 06/30/2002
8	The procedure code is inconsistent with the provider type/specialty (taxonomy). Start: 01/01/1995 \| Last Modified: 06/30/2002
9	The diagnosis is inconsistent with the patient's age. Start: 01/01/1995
10	The diagnosis is inconsistent with the patient's gender. Start: 01/01/1995 \| Last Modified: 02/29/2000
11	The diagnosis is inconsistent with the procedure. Start: 01/01/1995
12	The diagnosis is inconsistent with the provider type. Start: 01/01/1995
13	The date of death precedes the date of service. Start: 01/01/1995
14	The date of birth follows the date of service. Start: 01/01/1995
15	The authorization number is missing, invalid, or does not apply to the billed services or provider. Start: 01/01/1995 \| Last Modified: 09/30/2007
16	Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 06/30/2006
17	Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 09/21/2008 \| Stop: 07/01/2009
18	Duplicate claim/service. Start: 01/01/1995
19	This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007
20	This injury/illness is covered by the liability carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007
21	This injury/illness is the liability of the no-fault carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007
22	This care may be covered by another payer per coordination of benefits. Start: 01/01/1995 \| Last Modified: 09/30/2007
23	The impact of prior payer(s) adjudication including payments and/or adjustments. Start: 01/01/1995 \| Last Modified: 09/30/2007
24	Charges are covered under a capitation agreement/managed care plan. Start: 01/01/1995 \| Last Modified: 09/30/2007
25	Payment denied. Your Stop loss deductible has not been met. Start: 01/01/1995 \| Stop: 04/01/2008
26	Expenses incurred prior to coverage. Start: 01/01/1995
27	Expenses incurred after coverage terminated. Start: 01/01/1995
28	Coverage not in effect at the time the service was provided. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Redundant to codes 26&27.
29	The time limit for filing has expired. Start: 01/01/1995
30	Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Start: 01/01/1995 \| Stop: 02/01/2006
31	Patient cannot be identified as our insured. Start: 01/01/1995 \| Last Modified: 09/30/2007
32	Our records indicate that this dependent is not an eligible dependent as defined. Start: 01/01/1995
33	Insured has no dependent coverage. Start: 01/01/1995 \| Last Modified: 09/30/2007
34	Insured has no coverage for newborns. Start: 01/01/1995 \| Last Modified: 09/30/2007
35	Lifetime benefit maximum has been reached. Start: 01/01/1995 \| Last Modified: 10/31/2002
36	Balance does not exceed co-payment amount. Start: 01/01/1995 \| Stop: 10/16/2003
37	Balance does not exceed deductible. Start: 01/01/1995 \| Stop: 10/16/2003
38	Services not provided or authorized by designated (network/primary care) providers. Start: 01/01/1995 \| Last Modified: 06/30/2003
39	Services denied at the time authorization/pre-certification was requested. Start: 01/01/1995
40	Charges do not meet qualifications for emergent/urgent care. This change to be effective 04/01/2010: Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
41	Discount agreed to in Preferred Provider contract. Start: 01/01/1995 \| Stop: 10/16/2003
42	Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45) Start: 01/01/1995 \| Last Modified: 10/31/2006 \| Stop: 06/01/2007
43	Gramm-Rudman reduction. Start: 01/01/1995 \| Stop: 07/01/2006
44	Prompt-pay discount. Start: 01/01/1995
45	Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). Start: 01/01/1995 \| Last Modified: 10/31/2006
46	This (these) service(s) is (are) not covered. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 96.
47	This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Start: 01/01/1995 \| Stop: 02/01/2006
48	This (these) procedure(s) is (are) not covered. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 96.
49	These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. Start: 01/01/1995
50	These are non-covered services because this is not deemed a 'medical necessity' by the payer. This change to be effective 04/01/2010: These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
51	These are non-covered services because this is a pre-existing condition Start: 01/01/1995
52	The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. Start: 01/01/1995 \| Stop: 02/01/2006
53	Services by an immediate relative or a member of the same household are not covered. Start: 01/01/1995
54	Multiple physicians/assistants are not covered in this case. This change to be effective 04/01/2010: Multiple physicians/assistants are not covered in this case. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
55	Procedure/treatment is deemed experimental/investigational by the payer. This change to be effective 04/01/2010: Procedure/treatment is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
56	Procedure/treatment has not been deemed 'proven to be effective' by the payer. This change to be effective 04/01/2010: Procedure/treatment has not been deemed `proven to be effective' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
57	Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Split into codes 150, 151, 152, 153 and 154.
58	Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. This change to be effective 04/01/2010: Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
59	Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) This change to be effective 04/01/2010: Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Note: Refer to the 835 Healthcare Policy Identification Segment, if present. Start: 01/01/1995 \| Last Modified: 07/01/2009
60	Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services. Start: 01/01/1995 \| Last Modified: 06/01/2008
61	Penalty for failure to obtain second surgical opinion. Start: 01/01/1995 \| Last Modified: 09/30/2007
62	Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. Start: 01/01/1995 \| Last Modified: 10/31/2006 \| Stop: 04/01/2007
63	Correction to a prior claim. Start: 01/01/1995 \| Stop: 10/16/2003
64	Denial reversed per Medical Review. Start: 01/01/1995 \| Stop: 10/16/2003
65	Procedure code was incorrect. This payment reflects the correct code. Start: 01/01/1995 \| Stop: 10/16/2003
66	Blood Deductible. Start: 01/01/1995
67	Lifetime reserve days. (Handled in QTY, QTY01=LA) Start: 01/01/1995 \| Stop: 10/16/2003
68	DRG weight. (Handled in CLP12) Start: 01/01/1995 \| Stop: 10/16/2003
69	Day outlier amount. Start: 01/01/1995
70	Cost outlier - Adjustment to compensate for additional costs. Start: 01/01/1995 \| Last Modified: 06/30/2001
71	Primary Payer amount. Start: 01/01/1995 \| Stop: 06/30/2000 Notes: Use code 23.
72	Coinsurance day. (Handled in QTY, QTY01=CD) Start: 01/01/1995 \| Stop: 10/16/2003
73	Administrative days. Start: 01/01/1995 \| Stop: 10/16/2003
74	Indirect Medical Education Adjustment. Start: 01/01/1995
75	Direct Medical Education Adjustment. Start: 01/01/1995
76	Disproportionate Share Adjustment. Start: 01/01/1995
77	Covered days. (Handled in QTY, QTY01=CA) Start: 01/01/1995 \| Stop: 10/16/2003
78	Non-Covered days/Room charge adjustment. Start: 01/01/1995
79	Cost Report days. (Handled in MIA15) Start: 01/01/1995 \| Stop: 10/16/2003
80	Outlier days. (Handled in QTY, QTY01=OU) Start: 01/01/1995 \| Stop: 10/16/2003
81	Discharges. Start: 01/01/1995 \| Stop: 10/16/2003
82	PIP days. Start: 01/01/1995 \| Stop: 10/16/2003
83	Total visits. Start: 01/01/1995 \| Stop: 10/16/2003
84	Capital Adjustment. (Handled in MIA) Start: 01/01/1995 \| Stop: 10/16/2003
85	Patient Interest Adjustment (Use Only Group code PR) Start: 01/01/1995 \| Last Modified: 07/09/2007 Notes: Only use when the payment of interest is the responsibility of the patient.
86	Statutory Adjustment. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Duplicative of code 45.
87	Transfer amount. Start: 01/01/1995
88	Adjustment amount represents collection against receivable created in prior overpayment. Start: 01/01/1995 \| Stop: 06/30/2007
89	Professional fees removed from charges. Start: 01/01/1995
90	Ingredient cost adjustment. This change to be effective 04/01/2010: Ingredient cost adjustment. Note: To be used for pharmaceuticals only. Start: 01/01/1995 \| Last Modified: 07/01/2009
91	Dispensing fee adjustment. Start: 01/01/1995
92	Claim Paid in full. Start: 01/01/1995 \| Stop: 10/16/2003
93	No Claim level Adjustments. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: As of 004010, CAS at the claim level is optional.
94	Processed in Excess of charges. Start: 01/01/1995
95	Plan procedures not followed. Start: 01/01/1995 \| Last Modified: 09/30/2007
96	Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 06/30/2006
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Start: 01/01/1995 \| Last Modified: 09/30/2007
98	The hospital must file the Medicare claim for this inpatient non-physician service. Start: 01/01/1995 \| Stop: 10/16/2003
99	Medicare Secondary Payer Adjustment Amount. Start: 01/01/1995 \| Stop: 10/16/2003
100	Payment made to patient/insured/responsible party/employer. Start: 01/01/1995 \| Last Modified: 01/27/2008
101	Predetermination: anticipated payment upon completion of services or claim adjudication. Start: 01/01/1995 \| Last Modified: 02/28/1999
102	Major Medical Adjustment. Start: 01/01/1995
103	Provider promotional discount (e.g., Senior citizen discount). Start: 01/01/1995 \| Last Modified: 06/30/2001
104	Managed care withholding. Start: 01/01/1995
105	Tax withholding. Start: 01/01/1995
106	Patient payment option/election not in effect. Start: 01/01/1995
107	The related or qualifying claim/service was not identified on this claim. Start: 01/01/1995 \| Last Modified: 09/30/2007
108	Rent/purchase guidelines were not met. Start: 01/01/1995 \| Last Modified: 09/30/2007
109	Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. Start: 01/01/1995
110	Billing date predates service date. Start: 01/01/1995
111	Not covered unless the provider accepts assignment. Start: 01/01/1995
112	Service not furnished directly to the patient and/or not documented. Start: 01/01/1995 \| Last Modified: 09/30/2007
113	Payment denied because service/procedure was provided outside the United States or as a result of war. Start: 01/01/1995 \| Last Modified: 02/28/2001 \| Stop: 06/30/2007 Notes: Use Codes 157, 158 or 159.
114	Procedure/product not approved by the Food and Drug Administration. Start: 01/01/1995
115	Procedure postponed, canceled, or delayed. Start: 01/01/1995 \| Last Modified: 09/30/2007
116	The advance indemnification notice signed by the patient did not comply with requirements. Start: 01/01/1995 \| Last Modified: 09/30/2007
117	Transportation is only covered to the closest facility that can provide the necessary care. Start: 01/01/1995 \| Last Modified: 09/30/2007
118	ESRD network support adjustment. Start: 01/01/1995 \| Last Modified: 09/30/2007
119	Benefit maximum for this time period or occurrence has been reached. Start: 01/01/1995 \| Last Modified: 02/29/2004
120	Patient is covered by a managed care plan. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Use code 24.
121	Indemnification adjustment - compensation for outstanding member responsibility. Start: 01/01/1995 \| Last Modified: 09/30/2007
122	Psychiatric reduction. Start: 01/01/1995
123	Payer refund due to overpayment. Start: 01/01/1995 \| Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals.
124	Payer refund amount - not our patient. Start: 01/01/1995 \| Last Modified: 06/30/1999 \| Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals.
125	Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 09/30/2007
126	Deductible -- Major Medical Start: 02/28/1997 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008 Notes: Use Group Code PR and code 1.
127	Coinsurance -- Major Medical Start: 02/28/1997 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008 Notes: Use Group Code PR and code 2.
128	Newborn's services are covered in the mother's Allowance. Start: 02/28/1997
129	Prior processing information appears incorrect. Start: 02/28/1997 \| Last Modified: 09/30/2007
130	Claim submission fee. Start: 02/28/1997 \| Last Modified: 06/30/2001
131	Claim specific negotiated discount. Start: 02/28/1997
132	Prearranged demonstration project adjustment. Start: 02/28/1997
133	The disposition of this claim/service is pending further review. Start: 02/28/1997 \| Last Modified: 10/31/1999
134	Technical fees removed from charges. Start: 10/31/1998
135	Interim bills cannot be processed. Start: 10/31/1998 \| Last Modified: 09/30/2007
136	Failure to follow prior payer's coverage rules. (Use Group Code OA). Start: 10/31/1998 \| Last Modified: 09/30/2007
137	Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Start: 02/28/1999 \| Last Modified: 09/30/2007
138	Appeal procedures not followed or time limits not met. Start: 06/30/1999 \| Last Modified: 09/30/2007
139	Contracted funding agreement - Subscriber is employed by the provider of services. Start: 06/30/1999
140	Patient/Insured health identification number and name do not match. Start: 06/30/1999
141	Claim spans eligible and ineligible periods of coverage. Start: 06/30/1999 \| Last Modified: 09/30/2007
142	Monthly Medicaid patient liability amount. Start: 06/30/2000 \| Last Modified: 09/30/2007
143	Portion of payment deferred. Start: 02/28/2001
144	Incentive adjustment, e.g. preferred product/service. Start: 06/30/2001
145	Premium payment withholding Start: 06/30/2002 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008 Notes: Use Group Code CO and code 45.
146	Diagnosis was invalid for the date(s) of service reported. Start: 06/30/2002 \| Last Modified: 09/30/2007
147	Provider contracted/negotiated rate expired or not on file. Start: 06/30/2002
148	Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 06/30/2002 \| Last Modified: 09/21/2008
149	Lifetime benefit maximum has been reached for this service/benefit category. Start: 10/31/2002
150	Payer deems the information submitted does not support this level of service. Start: 10/31/2002 \| Last Modified: 09/30/2007
151	Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. Start: 10/31/2002 \| Last Modified: 01/27/2008
152	Payer deems the information submitted does not support this length of service. Start: 10/31/2002 \| Last Modified: 09/30/2007
153	Payer deems the information submitted does not support this dosage. Start: 10/31/2002 \| Last Modified: 09/30/2007
154	Payer deems the information submitted does not support this day's supply. Start: 10/31/2002 \| Last Modified: 09/30/2007
155	Patient refused the service/procedure. Start: 06/30/2003 \| Last Modified: 09/30/2007
156	Flexible spending account payments. Note: Use code 187. Start: 09/30/2003 \| Last Modified: 01/25/2009 \| Stop: 10/01/2009
157	Service/procedure was provided as a result of an act of war. Start: 09/30/2003 \| Last Modified: 09/30/2007
158	Service/procedure was provided outside of the United States. Start: 09/30/2003 \| Last Modified: 09/30/2007
159	Service/procedure was provided as a result of terrorism. Start: 09/30/2003 \| Last Modified: 09/30/2007
160	Injury/illness was the result of an activity that is a benefit exclusion. Start: 09/30/2003 \| Last Modified: 09/30/2007
161	Provider performance bonus Start: 02/29/2004
162	State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Start: 02/29/2004
163	Attachment referenced on the claim was not received. Start: 06/30/2004 \| Last Modified: 09/30/2007
164	Attachment referenced on the claim was not received in a timely fashion. Start: 06/30/2004 \| Last Modified: 09/30/2007
165	Referral absent or exceeded. Start: 10/31/2004 \| Last Modified: 09/30/2007
166	These services were submitted after this payers responsibility for processing claims under this plan ended. Start: 02/28/2005
167	This (these) diagnosis(es) is (are) not covered. Start: 06/30/2005
168	Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan. Start: 06/30/2005 \| Last Modified: 09/30/2007
169	Alternate benefit has been provided. Start: 06/30/2005 \| Last Modified: 09/30/2007
170	Payment is denied when performed/billed by this type of provider. Start: 06/30/2005
171	Payment is denied when performed/billed by this type of provider in this type of facility. Start: 06/30/2005
172	Payment is adjusted when performed/billed by a provider of this specialty Start: 06/30/2005
173	Service was not prescribed by a physician. Start: 06/30/2005 \| Last Modified: 09/30/2007
174	Service was not prescribed prior to delivery. Start: 06/30/2005 \| Last Modified: 09/30/2007
175	Prescription is incomplete. Start: 06/30/2005 \| Last Modified: 09/30/2007
176	Prescription is not current. Start: 06/30/2005 \| Last Modified: 09/30/2007
177	Patient has not met the required eligibility requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
178	Patient has not met the required spend down requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
179	Patient has not met the required waiting requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
180	Patient has not met the required residency requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007
181	Procedure code was invalid on the date of service. Start: 06/30/2005 \| Last Modified: 09/30/2007
182	Procedure modifier was invalid on the date of service. Start: 06/30/2005 \| Last Modified: 09/30/2007
183	The referring provider is not eligible to refer the service billed. Start: 06/30/2005
184	The prescribing/ordering provider is not eligible to prescribe/order the service billed. Start: 06/30/2005
185	The rendering provider is not eligible to perform the service billed. Start: 06/30/2005
186	Level of care change adjustment. Start: 06/30/2005 \| Last Modified: 09/30/2007
187	Health Savings account payments. This change to be effective 10/1/2009: Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.) Start: 06/30/2005 \| Last Modified: 01/25/2009
188	This product/procedure is only covered when used according to FDA recommendations. Start: 06/30/2005
189	'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service Start: 06/30/2005
190	Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Start: 10/31/2005
191	Not a work related injury/illness and thus not the liability of the workers' compensation carrier. Start: 10/31/2005 \| Last Modified: 09/30/2007
192	Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. Start: 10/31/2005 \| Last Modified: 09/30/2007
193	Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly. Start: 02/28/2006 \| Last Modified: 01/27/2008
194	Anesthesia performed by the operating physician, the assistant surgeon or the attending physician. Start: 02/28/2006 \| Last Modified: 09/30/2007
195	Refund issued to an erroneous priority payer for this claim/service. Start: 02/28/2006 \| Last Modified: 09/30/2007
196	Claim/service denied based on prior payer's coverage determination. Start: 06/30/2006 \| Stop: 02/01/2007 Notes: Use code 136.
197	Precertification/authorization/notification absent. Start: 10/31/2006 \| Last Modified: 09/30/2007
198	Precertification/authorization exceeded. Start: 10/31/2006 \| Last Modified: 09/30/2007
199	Revenue code and Procedure code do not match. Start: 10/31/2006
200	Expenses incurred during lapse in coverage Start: 10/31/2006
201	Workers Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. (Use group code PR). Start: 10/31/2006
202	Non-covered personal comfort or convenience services. Start: 02/28/2007 \| Last Modified: 09/30/2007
203	Discontinued or reduced service. Start: 02/28/2007 \| Last Modified: 09/30/2007
204	This service/equipment/drug is not covered under the patient's current benefit plan Start: 02/28/2007
205	Pharmacy discount card processing fee Start: 07/09/2007
206	National Provider Identifier - missing. Start: 07/09/2007 \| Last Modified: 09/30/2007
207	National Provider identifier - Invalid format Start: 07/09/2007 \| Last Modified: 06/01/2008
208	National Provider Identifier - Not matched. Start: 07/09/2007 \| Last Modified: 09/30/2007
209	Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use Group code OA) Start: 07/09/2007
210	Payment adjusted because pre-certification/authorization not received in a timely fashion Start: 07/09/2007
211	National Drug Codes (NDC) not eligible for rebate, are not covered. Start: 07/09/2007
212	Administrative surcharges are not covered Start: 11/05/2007
213	Non-compliance with the physician self referral prohibition legislation or payer policy. Start: 01/27/2008
214	Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. (Note: To be used for Workers' Compensation only) Start: 01/27/2008
215	Based on subrogation of a third party settlement Start: 01/27/2008
216	Based on the findings of a review organization Start: 01/27/2008
217	Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. (Note: To be used for Workers' Compensation only) Start: 01/27/2008
218	Based on entitlement to benefits (Note: To be used for Workers' Compensation only) Start: 01/27/2008
219	Based on extent of injury (Note: To be used for Workers' Compensation only) Start: 01/27/2008
220	The applicable fee schedule does not contain the billed code. Please resubmit a bill with the appropriate fee schedule code(s) that best describe the service(s) provided and supporting documentation if required. (Note: To be used for Workers' Compensation only) Start: 01/27/2008
221	Workers' Compensation claim is under investigation. (Note: To be used for Workers' Compensation only. Claim pending final resolution) Start: 01/27/2008
222	Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Start: 06/01/2008
223	Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. Start: 06/01/2008
224	Patient identification compromised by identity theft. Identity verification required for processing this and future claims. Start: 06/01/2008
225	Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837) Start: 06/01/2008
226	Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 09/21/2008
227	Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 09/21/2008
228	Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication Start: 09/21/2008
229	Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. Use Group Code PR. Start: 01/25/2009
230	No available or correlating CPT/HCPCS code to describe this service. Note: Used only by Property and Casualty. Start: 01/25/2009
231	Mutually exclusive procedures cannot be done in the same day/setting. Start: 01/01/2010 Notes: Refer to the 835 Healthcare Policy Identification Segment, if present
A0	Patient refund amount. Start: 01/01/1995
A1	Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 10/31/2006
A2	Contractual adjustment. Start: 01/01/1995 \| Last Modified: 02/28/2007 \| Stop: 01/01/2008 Notes: Use Code 45 with Group Code 'CO' or use another appropriate specific adjustment code.
A3	Medicare Secondary Payer liability met. Start: 01/01/1995 \| Stop: 10/16/2003
A4	Medicare Claim PPS Capital Day Outlier Amount. Start: 01/01/1995 \| Last Modified: 09/30/2007 \| Stop: 04/01/2008
A5	Medicare Claim PPS Capital Cost Outlier Amount. Start: 01/01/1995
A6	Prior hospitalization or 30 day transfer requirement not met. Start: 01/01/1995
A7	Presumptive Payment Adjustment Start: 01/01/1995
A8	Ungroupable DRG. Start: 01/01/1995 \| Last Modified: 09/30/2007
B1	Non-covered visits. Start: 01/01/1995
B2	Covered visits. Start: 01/01/1995 \| Stop: 10/16/2003
B3	Covered charges. Start: 01/01/1995 \| Stop: 10/16/2003
B4	Late filing penalty. Start: 01/01/1995
B5	Coverage/program guidelines were not met or were exceeded. Start: 01/01/1995 \| Last Modified: 09/30/2007
B6	This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. Start: 01/01/1995 \| Stop: 02/01/2006
B7	This provider was not certified/eligible to be paid for this procedure/service on this date of service. Start: 01/01/1995 \| Last Modified: 10/31/1998
B8	Alternative services were available, and should have been utilized. Start: 01/01/1995 \| Last Modified: 09/30/2007
B9	Patient is enrolled in a Hospice. Start: 01/01/1995 \| Last Modified: 09/30/2007
B10	Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test. Start: 01/01/1995
B11	The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. Start: 01/01/1995
B12	Services not documented in patients' medical records. Start: 01/01/1995
B13	Previously paid. Payment for this claim/service may have been provided in a previous payment. Start: 01/01/1995
B14	Only one visit or consultation per physician per day is covered. Start: 01/01/1995 \| Last Modified: 09/30/2007
B15	This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Start: 01/01/1995 \| Last Modified: 09/30/2007
B16	'New Patient' qualifications were not met. Start: 01/01/1995 \| Last Modified: 09/30/2007
B17	Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current. Start: 01/01/1995 \| Stop: 02/01/2006
B18	This procedure code and modifier were invalid on the date of service. Start: 01/01/1995 \| Last Modified: 09/21/2008 \| Stop: 03/01/2009
B19	Claim/service adjusted because of the finding of a Review Organization. Start: 01/01/1995 \| Stop: 10/16/2003
B20	Procedure/service was partially or fully furnished by another provider. Start: 01/01/1995 \| Last Modified: 09/30/2007
B21	The charges were reduced because the service/care was partially furnished by another physician. Start: 01/01/1995 \| Stop: 10/16/2003
B22	This payment is adjusted based on the diagnosis. Start: 01/01/1995 \| Last Modified: 02/28/2001
B23	Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Start: 01/01/1995 \| Last Modified: 09/30/2007
D1	Claim/service denied. Level of subluxation is missing or inadequate. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D2	Claim lacks the name, strength, or dosage of the drug furnished. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D3	Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D4	Claim/service does not indicate the period of time for which this will be needed. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D5	Claim/service denied. Claim lacks individual lab codes included in the test. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D6	Claim/service denied. Claim did not include patient's medical record for the service. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D7	Claim/service denied. Claim lacks date of patient's most recent physician visit. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D8	Claim/service denied. Claim lacks indicator that 'x-ray is available for review.' Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D9	Claim/service denied. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary.
D10	Claim/service denied. Completed physician financial relationship form not on file. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D11	Claim lacks completed pacemaker registration form. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D12	Claim/service denied. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test. Start: 01/01/1995 \| Stop: 10/16/2003 Notes: Use code 17.
D13	Claim/service denied. Performed by a facili