Help | My Account | Checkout
Home
WPC Services
HIPAA
EDI Publications
EDI Standards
EDI Table Data
Code Lists

Remittance Advice Remark Codes

Change Request Form
On-Line Conference FAQs

Remittance Advice Remark Codes - All

Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List.

Last Update: 7/1/2009

M1X-ray not taken within the past 12 months or near enough to the start of treatment.
Start: 01/01/1997
M2Not paid separately when the patient is an inpatient.
Start: 01/01/1997
M3Equipment is the same or similar to equipment already being used.
Start: 01/01/1997
M4Alert: This is the last monthly installment payment for this durable medical equipment.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M5Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
Start: 01/01/1997
M6Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
Start: 01/01/1997 | Last Modified: 03/01/2009
Notes: (Modified 4/1/07, 3/1/2009)
M7No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.
Start: 01/01/1997
M8We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
Start: 01/01/1997
M9Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M10Equipment purchases are limited to the first or the tenth month of medical necessity.
Start: 01/01/1997
M11DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
Start: 01/01/1997
M12Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
Start: 01/01/1997
M13Only one initial visit is covered per specialty per medical group.
Start: 01/01/1997 | Last Modified: 06/30/2007
Notes: (Modified 6/30/03)
M14No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.
Start: 01/01/1997
M15Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
Start: 01/01/1997
M16Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07)
M17Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M18Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M19Missing oxygen certification/re-certification.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N234
M20Missing/incomplete/invalid HCPCS.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M21Missing/incomplete/invalid place of residence for this service/item provided in a home.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M22Missing/incomplete/invalid number of miles traveled.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M23Missing invoice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
M24Missing/incomplete/invalid number of doses per vial.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M25The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request a appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07)
M26The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service /any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice.

The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)
M27Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)
M28This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
Start: 01/01/1997
M29Missing operative note/report.
Start: 01/01/1997 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N233
M30Missing pathology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N236
M31Missing radiology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N240
M32Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M33Missing/incomplete/invalid UPIN for the ordering/referring/performing provider.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using M68
M34Claim lacks the CLIA certification number.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA120
M35Missing/incomplete/invalid pre-operative photos or visual field results.
Start: 01/01/1997 | Stop: 02/05/2005
Notes: Consider using N178
M36This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.
Start: 01/01/1997
M37Service not covered when the patient is under age 35.
Start: 01/01/1997
M38The patient is liable for the charges for this service as you informed the patient in writing before the service was furnished that we would not pay for it, and the patient agreed to pay.
Start: 01/01/1997
M39Alert: The patient is not liable for payment for this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 2/1/04, 4/1/07)
M40Claim must be assigned and must be filed by the practitioner's employer.
Start: 01/01/1997
M41We do not pay for this as the patient has no legal obligation to pay for this.
Start: 01/01/1997
M42The medical necessity form must be personally signed by the attending physician.
Start: 01/01/1997
M43Payment for this service previously issued to you or another provider by another carrier/intermediary.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using Reason Code 23
M44Missing/incomplete/invalid condition code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M45Missing/incomplete/invalid occurrence code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N299
M46Missing/incomplete/invalid occurrence span code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N300
M47Missing/incomplete/invalid internal or document control number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M48Payment for services furnished to hospital inpatients (other than professional services of physicians) can only be made to the hospital. You must request payment from the hospital rather than the patient for this service.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M97
M49Missing/incomplete/invalid value code(s) or amount(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M50Missing/incomplete/invalid revenue code(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M51Missing/incomplete/invalid procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N301
M52Missing/incomplete/invalid "from" date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M53Missing/incomplete/invalid days or units of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M54Missing/incomplete/invalid total charges.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M55We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
Start: 01/01/1997
M56Missing/incomplete/invalid payer identifier.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M57Missing/incomplete/invalid provider identifier.
Start: 01/01/1997 | Stop: 06/02/2005
M58Missing/incomplete/invalid claim information. Resubmit claim after corrections.
Start: 01/01/1997 | Stop: 02/05/2005
M59Missing/incomplete/invalid "to" date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M60Missing Certificate of Medical Necessity.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 6/30/03) Related to N227
M61We cannot pay for this as the approval period for the FDA clinical trial has expired.
Start: 01/01/1997
M62Missing/incomplete/invalid treatment authorization code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M63We do not pay for more than one of these on the same day.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M86
M64Missing/incomplete/invalid other diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M65One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.
Start: 01/01/1997
M66Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.
Start: 01/01/1997
M67Missing/incomplete/invalid other procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N302
M68Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.
Start: 01/01/1997 | Stop: 06/02/2005
M69Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M70Alert: The NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/2007, 8/1/07)
M71Total payment reduced due to overlap of tests billed.
Start: 01/01/1997
M72Did not enter full 8-digit date (MM/DD/CCYY).
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA52
M73The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04)
M74This service does not qualify for a HPSA/Physician Scarcity bonus payment.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
M75Multiple automated multichannel tests performed on the same day combined for payment.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M76Missing/incomplete/invalid diagnosis or condition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M77Missing/incomplete/invalid place of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M78Missing/incomplete/invalid HCPCS modifier.
Start: 01/01/1997 | Stop: 05/18/2006 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03,) Consider using Reason Code 4
M79Missing/incomplete/invalid charge.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M80Not covered when performed during the same session/date as a previously processed service for the patient.
Start: 01/01/1997 | Last Modified: 10/31/2002
Notes: (Modified 10/31/02)
M81You are required to code to the highest level of specificity.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M82Service is not covered when patient is under age 50.
Start: 01/01/1997
M83Service is not covered unless the patient is classified as at high risk.
Start: 01/01/1997
M84Medical code sets used must be the codes in effect at the time of service
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M85Subjected to review of physician evaluation and management services.
Start: 01/01/1997
M86Service denied because payment already made for same/similar procedure within set time frame.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M87Claim/service(s) subjected to CFO-CAP prepayment review.
Start: 01/01/1997
M88We cannot pay for laboratory tests unless billed by the laboratory that did the work.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using Reason Code B20
M89Not covered more than once under age 40.
Start: 01/01/1997
M90Not covered more than once in a 12 month period.
Start: 01/01/1997
M91Lab procedures with different CLIA certification numbers must be billed on separate claims.
Start: 01/01/1997
M92Services subjected to review under the Home Health Medical Review Initiative.
Start: 01/01/1997 | Stop: 08/01/2004
M93Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
Start: 01/01/1997
M94Information supplied does not support a break in therapy. A new capped rental period will not begin.
Start: 01/01/1997
M95Services subjected to Home Health Initiative medical review/cost report audit.
Start: 01/01/1997
M96The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.
Start: 01/01/1997
M97Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
Start: 01/01/1997
M98Begin to report the Universal Product Number on claims for items of this type. We will soon begin to deny payment for items of this type if billed without the correct UPN.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M99
M99Missing/incomplete/invalid Universal Product Number/Serial Number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M100We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug.
Start: 01/01/1997
M101Begin to report a G1-G5 modifier with this HCPCS. We will soon begin to deny payment for this service if billed without a G1-G5 modifier.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M78
M102Service not performed on equipment approved by the FDA for this purpose.
Start: 01/01/1997
M103Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.
Start: 01/01/1997
M104Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.
Start: 01/01/1997
M105Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.
Start: 01/01/1997
M106Information supplied does not support a break in therapy. A new capped rental period will not begin. This is the maximum approved under the fee schedule for this item or service.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using MA 31
M107Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
Start: 01/01/1997
M108Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test.
Start: 01/01/1997 | Stop: 06/02/2005
M109We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
Start: 01/01/1997
M110Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services.
Start: 01/01/1997 | Stop: 06/02/2005
M111We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
Start: 01/01/1997
M112Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M113Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M114This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 8/1/06, 11/5/07)
M115This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/2007)
M116Paid under the Competitive Bidding Demonstration project. Project is ending, and future services may not be paid under this project.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M117Not covered unless submitted via electronic claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M118Alert: Letter to follow containing further information.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M119Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 2/28/03, 4/1/04)
M120Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens arrangement.
Start: 01/01/1997 | Stop: 06/02/2005
M121We pay for this service only when performed with a covered cryosurgical ablation.
Start: 01/01/1997
M122Missing/incomplete/invalid level of subluxation.
Start: 01/01/1997 | Last Modified: 02/28/2006
Notes: (Modified 2/28/03)
M123Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M124Missing indication of whether the patient owns the equipment that requires the part or supply.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N230
M125Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M126Missing/incomplete/invalid individual lab codes included in the test.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M127Missing patient medical record for this service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N237
M128Missing/incomplete/invalid date of the patient's last physician visit.
Start: 01/01/1997 | Stop: 06/02/2005
M129Missing/incomplete/invalid indicator of x-ray availability for review.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 2/28/03, 6/30/03)
M130Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N231
M131Missing physician financial relationship form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N239
M132Missing pacemaker registration form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N235
M133Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
Start: 01/01/1997
M134Performed by a facility/supplier in which the provider has a financial interest.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M135Missing/incomplete/invalid plan of treatment.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M136Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M137Part B coinsurance under a demonstration project.
Start: 01/01/1997
M138Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.
Start: 01/01/1997
M139Denied services exceed the coverage limit for the demonstration.
Start: 01/01/1997
M140Service not covered until after the patient's 50th birthday, i.e., no coverage prior to the day after the 50th birthday
Start: 01/01/1997 | Stop: 01/30/2004
Notes: Consider using M82
M141Missing physician certified plan of care.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N238
M142Missing American Diabetes Association Certificate of Recognition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N226
M143The provider must update license information with the payer.
Start: 01/01/1997 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06)
M144Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
Start: 01/01/1997
MA01Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)
MA02Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)
MA03If you do not agree with the approved amounts and $100 or more is in dispute (less deductible and coinsurance), you may ask for a hearing within six months of the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time.
Start: 01/01/1997 | Stop: 10/01/2006 | Last Modified: 11/18/2005
Notes: Consider using MA02 (Modified 10/31/02, 6/30/03, 8/1/05, 11/18/05)
MA04Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
Start: 01/01/1997
MA05Incorrect admission date patient status or type of bill entry on claim.
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA30, MA40 or MA43
MA06Missing/incomplete/invalid beginning and/or ending date(s).
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA31
MA07Alert: The claim information has also been forwarded to Medicaid for review.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA08Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA09Claim submitted as unassigned but processed as assigned. You agreed to accept assignment for all claims.
Start: 01/01/1997
MA10Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA11Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M32
MA12You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).
Start: 01/01/1997
MA13Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA14Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)
MA15Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA16The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
Start: 01/01/1997
MA17We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.
Start: 01/01/1997
MA18Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA19Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA20Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA21SSA records indicate mismatch with name and sex.
Start: 01/01/1997
MA22Payment of less than $1.00 suppressed.
Start: 01/01/1997
MA23Demand bill approved as result of medical review.
Start: 01/01/1997
MA24Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA25A patient may not elect to change a hospice provider more than once in a benefit period.
Start: 01/01/1997
MA26Alert: Our records indicate that you were previously informed of this rule.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA27Missing/incomplete/invalid entitlement number or name shown on the claim.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA28Alert: Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA29Missing/incomplete/invalid provider name, city, state, or zip code.
Start: 01/01/1997 | Stop: 06/02/2005
MA30Missing/incomplete/invalid type of bill.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA31Missing/incomplete/invalid beginning and ending dates of the period billed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA32Missing/incomplete/invalid number of covered days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA33Missing/incomplete/invalid noncovered days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA34Missing/incomplete/invalid number of coinsurance days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA35Missing/incomplete/invalid number of lifetime reserve days.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA36Missing/incomplete/invalid patient name.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA37Missing/incomplete/invalid patient's address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA38Missing/incomplete/invalid birth date.
Start: 01/01/1997 | Stop: 06/02/2005
MA39Missing/incomplete/invalid gender.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA40Missing/incomplete/invalid admission date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA41Missing/incomplete/invalid admission type.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA42Missing/incomplete/invalid admission source.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA43Missing/incomplete/invalid patient status.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA44Alert: No appeal rights. Adjudicative decision based on law.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA45Alert: As previously advised, a portion or all of your payment is being held in a special account.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA46The new information was considered but additional payment will not be issued.
Start: 01/01/1997 | Last Modified: 03/01/2009
Notes: (Modified 3/1/2009)
MA47Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.
Start: 01/01/1997
MA48Missing/incomplete/invalid name or address of responsible party or primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA49Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA76
MA50Missing/incomplete/invalid Investigational Device Exemption number for FDA-approved clinical trial services.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA51Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.
Start: 01/01/1997 | Stop: 02/05/2005
Notes: Consider using MA120
MA52Missing/incomplete/invalid date.
Start: 01/01/1997 | Stop: 06/02/2005
MA53Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
MA54Physician certification or election consent for hospice care not received timely.
Start: 01/01/1997
MA55Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
Start: 01/01/1997
MA56Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.
Start: 01/01/1997
MA57Patient submitted written request to revoke his/her election for religious non-medical health care services.
Start: 01/01/1997
MA58Missing/incomplete/invalid release of information indicator.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA59Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA60Missing/incomplete/invalid patient relationship to insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA61Missing/incomplete/invalid social security number or health insurance claim number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA62Alert: This is a telephone review decision.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)
MA63Missing/incomplete/invalid principal diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA64Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
Start: 01/01/1997
MA65Missing/incomplete/invalid admitting diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA66Missing/incomplete/invalid principal procedure code.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N303
MA67Correction to a prior claim.
Start: 01/01/1997
MA68Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA69Missing/incomplete/invalid remarks.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA70Missing/incomplete/invalid provider representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA71Missing/incomplete/invalid provider representative signature date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA72Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA73Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
Start: 01/01/1997
MA74This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
Start: 01/01/1997
MA75Missing/incomplete/invalid patient or authorized representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA76Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03, 2/1/04)
MA77Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient's payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA78The patient overpaid you. You must issue the patient a refund within 30 days for the difference between our allowed amount total and the amount paid by the patient.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using MA59
MA79Billed in excess of interim rate.
Start: 01/01/1997
MA80Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.
Start: 01/01/1997
MA81Missing/incomplete/invalid provider/supplier signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA82Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number.
Start: 01/01/1997 | Stop: 06/02/2005
MA83Did not indicate whether we are the primary or secondary payer.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
MA84Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.
Start: 01/01/1997
MA85Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program name or identification number. Enter the PlanID when effective.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA86Missing/incomplete/invalid group or policy number of the insured for the primary coverage.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA87Missing/incomplete/invalid insured's name for the primary payer.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA88Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA89Missing/incomplete/invalid patient's relationship to the insured for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA90Missing/incomplete/invalid employment status code for the primary insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03).
MA91This determination is the result of the appeal you filed.
Start: 01/01/1997
MA92Missing plan information for other insurance.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04) Related to N245
MA93Non-PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA94Did not enter the statement "Attending physician not hospice employee" on the claim form to certify that the rendering physician is not an employee of the hospice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Reactivated 4/1/04, Modified 8/1/05)
MA95A not otherwise classified or unlisted procedure code(s) was billed but a narrative description of the procedure was not entered on the claim. Refer to item 19 on the HCFA-1500.
Start: 01/01/1997 | Stop: 01/01/2004 | Last Modified: 02/28/2003
Notes: (Deactivated 2/28/2003) (Erroneous description corrected 9/2/2008) Consider using M51
MA96Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
Start: 01/01/1997
MA97Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
Start: 01/01/1997 | Last Modified: 02/29/2008
Notes: (Modified 2/29/08)
MA98Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary.
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA97
MA99Missing/incomplete/invalid Medigap information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA100Missing/incomplete/invalid date of current illness or symptoms
Start: 01/01/1997 | Last Modified: 03/30/2005
Notes: (Modified 2/28/03, 3/30/05)
MA101A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA102Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using M68
MA103Hemophilia Add On.
Start: 01/01/1997
MA104Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M128 or M57
MA105Missing/incomplete/invalid provider number for this place of service.
Start: 01/01/1997 | Stop: 06/02/2005
MA106PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA107Paper claim contains more than three separate data items in field 19.
Start: 01/01/1997
MA108Paper claim contains more than one data item in field 23.
Start: 01/01/1997
MA109Claim processed in accordance with ambulatory surgical guidelines.
Start: 01/01/1997
MA110Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA111Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA112Missing/incomplete/invalid group practice information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA113Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.
Start: 01/01/1997
MA114Missing/incomplete/invalid information on where the services were furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA115Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA116Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.
Start: 01/01/1997
Notes: (Reactivated 4/1/04)
MA117This claim has been assessed a $1.00 user fee.
Start: 01/01/1997
MA118Coinsurance and/or deductible amounts apply to a claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. No Medicare payment issued.
Start: 01/01/1997
MA119Provider level adjustment for late claim filing applies to this claim.
Start: 01/01/1997 | Stop: 05/01/2008 | Last Modified: 11/05/2007
Notes: Consider using Reason Code B4
MA120Missing/incomplete/invalid CLIA certification number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA121Missing/incomplete/invalid x-ray date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
MA122Missing/incomplete/invalid initial treatment date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
MA123Your center was not selected to participate in this study, therefore, we cannot pay for these services.
Start: 01/01/1997
MA124Processed for IME only.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using Reason Code 74
MA125Per legislation governing this program, payment constitutes payment in full.
Start: 01/01/1997
MA126Pancreas transplant not covered unless kidney transplant performed.
Start: 10/12/2001
MA127Reserved for future use.
Start: 10/12/2001 | Stop: 06/02/2005
MA128Missing/incomplete/invalid FDA approval number.
Start: 10/12/2001 | Last Modified: 03/30/2005
Notes: (Modified 2/28/03, 3/30/05)
MA129This provider was not certified for this procedure on this date of service.
Start: 10/12/2001 | Stop: 01/31/2004 | Last Modified: 01/31/2004
Notes: Consider using MA120 and Reason Code B7
MA130Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
Start: 10/12/2001
MA131Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.
Start: 10/12/2001
MA132Adjustment to the pre-demonstration rate.
Start: 10/12/2001
MA133Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
Start: 10/12/2001
MA134Missing/incomplete/invalid provider number of the facility where the patient resides.
Start: 10/12/2001
N1Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 2/28/03, 4/1/07)
N2This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
Start: 01/01/2000
N3Missing consent form.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N228
N4Missing/incomplete/invalid prior insurance carrier EOB.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N5EOB received from previous payer. Claim not on file.
Start: 01/01/2000
N6Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N7Processing of this claim/service has included consideration under Major Medical provisions.
Start: 01/01/2000
N8Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
Start: 01/01/2000
N9Adjustment represents the estimated amount a previous payer may pay.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)
N10Payment based on the findings of a review organization/professional consult/manual adjudication/medical or dental advisor.
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 10/31/02, 7/1/08)
N11Denial reversed because of medical review.
Start: 01/01/2000
N12Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.
Start: 01/01/2000 | Last Modified: 08/01/2007
Notes: (Modified 8/1/07)
N13Payment based on professional/technical component modifier(s).
Start: 01/01/2000
N14Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.
Start: 01/01/2000 | Stop: 10/01/2007
Notes: Consider using Reason Code 45
N15Services for a newborn must be billed separately.
Start: 01/01/2000
N16Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
Start: 01/01/2000
N17Per admission deductible.
Start: 01/01/2000 | Stop: 08/01/2004
Notes: Consider using Reason Code 1
N18Payment based on the Medicare allowed amount.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using N14
N19Procedure code incidental to primary procedure.
Start: 01/01/2000
N20Service not payable with other service rendered on the same date.
Start: 01/01/2000
N21Alert: Your line item has been separated into multiple lines to expedite handling.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/1/05, 4/1/07)
N22This procedure code was added/changed because it more accurately describes the services rendered.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 10/31/02, 2/28/03)
N23Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/13/01, 4/1/07)
N24Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N25This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.
Start: 01/01/2000
N26Missing itemized bill/statement.
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N232
N27Missing/incomplete/invalid treatment number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N28Consent form requirements not fulfilled.
Start: 01/01/2000
N29Missing documentation/orders/notes/summary/report/chart.
Start: 01/01/2000 | Last Modified: 08/01/2005
Notes: (Modified 2/28/03, 8/1/05) Related to N225
N30Patient ineligible for this service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N31Missing/incomplete/invalid prescribing provider identifier.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
N32Claim must be submitted by the provider who rendered the service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N33No record of health check prior to initiation of treatment.
Start: 01/01/2000
N34Incorrect claim form/format for this service.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)
N35Program integrity/utilization review decision.
Start: 01/01/2000
N36Claim must meet primary payer's processing requirements before we can consider payment.
Start: 01/01/2000
N37Missing/incomplete/invalid tooth number/letter.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N38Missing/incomplete/invalid place of service.
Start: 01/01/2000 | Stop: 02/05/2005
Notes: Consider using M77
N39Procedure code is not compatible with tooth number/letter.
Start: 01/01/2000
N40Missing radiology film(s)/image(s).
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/1/04, 7/1/08) Related to N242
N41Authorization request denied.
Start: 01/01/2000 | Stop: 10/16/2003
Notes: Consider using Reason Code 39
N42No record of mental health assessment.
Start: 01/01/2000
N43Bed hold or leave days exceeded.
Start: 01/01/2000
N44Payer's share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority.
Start: 01/01/2000 | Stop: 10/16/2003
Notes: Consider using Reason Code 137
N45Payment based on authorized amount.
Start: 01/01/2000
N46Missing/incomplete/invalid admission hour.
Start: 01/01/2000
N47Claim conflicts with another inpatient stay.
Start: 01/01/2000
N48Claim information does not agree with information received from other insurance carrier.
Start: 01/01/2000
N49Court ordered coverage information needs validation.
Start: 01/01/2000
N50Missing/incomplete/invalid discharge information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N51Electronic interchange agreement not on file for provider/submitter.
Start: 01/01/2000
N52Patient not enrolled in the billing provider's managed care plan on the date of service.
Start: 01/01/2000
N53Missing/incomplete/invalid point of pick-up address.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N54Claim information is inconsistent with pre-certified/authorized services.
Start: 01/01/2000
N55Procedures for billing with group/referring/performing providers were not followed.
Start: 01/01/2000
N56Procedure code billed is not correct/valid for the services billed or the date of service billed.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N57Missing/incomplete/invalid prescribing date.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N304
N58Missing/incomplete/invalid patient liability amount.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N59Alert: Please refer to your provider manual for additional program and provider information.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N60A valid NDC is required for payment of drug claims effective October 02.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using M119
N61Rebill services on separate claims.
Start: 01/01/2000
N62Inpatient admission spans multiple rate periods. Resubmit separate claims.
Start: 01/01/2000
N63Rebill services on separate claim lines.
Start: 01/01/2000
N64The "from" and "to" dates must be different.
Start: 01/01/2000
N65Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N66Missing/incomplete/invalid documentation.
Start: 01/01/2000 | Stop: 02/05/2005
Notes: Consider using N29 or N225.
N67Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient's admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.
Start: 01/01/2000
N68Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.
Start: 01/01/2000
N69PPS (Prospective Payment System) code changed by claims processing system. Insufficient visits or therapies.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N70Consolidated billing and payment applies.
Start: 01/01/2000 | Last Modified: 11/05/2007
Notes: (Modified 2/28/02, 11/5/07)
N71Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 2/21/02, 6/30/03)
N72PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N73A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using MA101 or N200
N74Resubmit with multiple claims, each claim covering services provided in only one calendar month.
Start: 01/01/2000
N75Missing/incomplete/invalid tooth surface information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N76Missing/incomplete/invalid number of riders.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N77Missing/incomplete/invalid designated provider number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N78The necessary components of the child and teen checkup (EPSDT) were not completed.
Start: 01/01/2000
N79Service billed is not compatible with patient location information.
Start: 01/01/2000
N80Missing/incomplete/invalid prenatal screening information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N81Procedure billed is not compatible with tooth surface code.
Start: 01/01/2000
N82Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
Start: 01/01/2000
N83No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
Start: 01/01/2000
N84Alert: Further installment payments are forthcoming.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N85Alert: This is the final installment payment.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N86A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
Start: 01/01/2000
N87Home use of biofeedback therapy is not covered.
Start: 01/01/2000
N88Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N89Alert: Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N90Covered only when performed by the attending physician.
Start: 01/01/2000
N91Services not included in the appeal review.
Start: 01/01/2000
N92This facility is not certified for digital mammography.
Start: 01/01/2000
N93A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
Start: 01/01/2000
N94Claim/Service denied because a more specific taxonomy code is required for adjudication.
Start: 01/01/2000
N95This provider type/provider specialty may not bill this service.
Start: 07/31/2001 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N96Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.
Start: 08/24/2001
N97Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.
Start: 08/24/2001
N98Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.
Start: 08/24/2001
N99Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
Start: 08/24/2001
N100PPS (Prospect Payment System) code corrected during adjudication.
Start: 09/14/2001 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N101Additional information is needed in order to process this claim. Please resubmit the claim with the identification number of the provider where this service took place. The Medicare number of the site of service provider should be preceded with the letters 'HSP' and entered into item #32 on the claim form. You may bill only one site of service provider number per claim.
Start: 10/31/2001 | Stop: 01/31/2004
Notes: Consider uisng MA105
N102This claim has been denied without reviewing the medical record because the requested records were not received or were not received timely.
Start: 10/31/2001
N103Social Security records indicate that this patient was a prisoner when the service was rendered. This payer does not cover items and services furnished to an individual while they are in State or local custody under a penal authority, unless under State or local law, the individual is personally liable for the cost of his or her health care while incarcerated and the State or local government pursues such debt in the same way and with the same vigor as any other debt.
Start: 10/31/2001 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N104This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.hhs.gov.
Start: 01/29/2002 | Last Modified: 10/31/2002