| 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 |
| 25 | Payment denied. Your Stop loss deductible has not been met.
Start: 01/01/1995 | Stop: 04/01/2008 |
| 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. |
| 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 |
| 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 |
| 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 |
| 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. |
| 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 |
| 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. |
| 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 |
| 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 |
| 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 |
| 77 | Covered days. (Handled in QTY, QTY01=CA)
Start: 01/01/1995 | Stop: 10/16/2003 |
| 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 |
| 86 | Statutory Adjustment.
Start: 01/01/1995 | Stop: 10/16/2003
Notes: Duplicative of code 45. |
| 88 | Adjustment amount represents collection against receivable created in prior overpayment.
Start: 01/01/1995 | Stop: 06/30/2007 |
| 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. |
| 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 |
| 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. |
| 120 | Patient is covered by a managed care plan.
Start: 01/01/1995 | Stop: 06/30/2007
Notes: Use code 24. |
| 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. |
| 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. |
| 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. |
| 156 | Flexible spending account payments. Note: Use code 187.
Start: 09/30/2003 | Last Modified: 01/25/2009 | Stop: 10/01/2009 |
| 196 | Claim/service denied based on prior payer's coverage determination.
Start: 06/30/2006 | Stop: 02/01/2007
Notes: Use code 136. |
| 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 |
| B2 | Covered visits.
Start: 01/01/1995 | Stop: 10/16/2003 |
| B3 | Covered charges.
Start: 01/01/1995 | Stop: 10/16/2003 |
| 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 |
| 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 |
| B21 | The charges were reduced because the service/care was partially furnished by another physician.
Start: 01/01/1995 | Stop: 10/16/2003 |
| 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 |
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