Automated Denial MSNs
Remittance
Med/Tech MSN Code Claim Adjustment
Coverage Area New Code LUAC UAC External Narrative Advice Remark
Ind. MSN Narrative Message Reason Code
Codes
Line level reason code to indicates that
16.10 167
the HCPCS on the line and a diagnosis
52NCD--Bene liable K Medicare does not pay for this This (these) diagnosis(es)
52NCD O NA code on the claim matched the NCD
statutory reason O/H item or service. is (are) not covered.
edit table list ICD-9-CM deny codes.
Service was denied.
Line level denial to indicates that none
of the diagnoses on the claim support
the medical necessity of the service. 50
15.4
Service was denied the beneficiary is These are non-covered
53NCD--Bene liable D The information provided does
53NCD O NA liable. The bene is liable because services because this is M38
modifier GA present O/H not support the need for this
modifier ‘GA’ is present on the line, or not deemed a ‚medical
service or item.
occurrence code 32 is present on the necessity‛ by the payer.
claim and modifier ‘GA’ is not present
on any claim line.
Line level reason code to indicates that 50
15.4
54NCD--Provider none of the diagnoses on the claim These are non-covered
C The information provided does
liable modifier GA 54NCD N M support the medical necessity of the services because this is M76
N/H not support the need for this
absent service. Service denied the provider is not deemed a ‚medical
service or item.
liable. necessity‛ by the payer.
14.9
This claim was denied by an B22
Medicare cannot pay for this
R&N C automated system for not having a This payment is adjusted N115
55A00 N M service for the diagnosis shown
No diagnosis N/H covered diagnosis in accordance to the based on the diagnosis. M76
on the claim.
LCD/NCD.
14.9
This claim was denied by an B22
R&N Medicare cannot pay for this N115
D automated system for not having a This payment is adjusted
No diagnosis 55A01 O NA service for the diagnosis shown M76
O/H covered diagnosis in accordance to the based on the diagnosis.
(beneficiary liable) on the claim. M38
LCD/NCD.
1 of 19 04/12/07
Remittance
Med/Tech MSN Code Claim Adjustment
Coverage Area New Code LUAC UAC External Narrative Advice Remark
Ind. MSN Narrative Message Reason Code
Codes
151
15.1
This claim was denied by an Payment adjusted because
The information provided does
automated system because the the payer deems the
R&N frequency C not support the need for this
55A02 N M information on the claim does not information submitted N115
(provider liable) N/H many services
support the frequency/duration of this does not support this
or items.
service as defined by the LCD/NCD. many services.
151
15.1
This claim was denied by an Payment adjusted because
The information provided does
automated system because the the payer deems the
R&N frequency D not support the need for this N115
55A03 O NA information on the claim does not information submitted
(Beneficiary liable) O/H many services M38
support the frequency/duration of this does not support this
or items.
service as defined by the LCD/NCD. many services.
A service or procedure designated by a
CPT category III code will be
considered investigational and,
therefore, not covered by Medicare by
21.22 55
statutory exclusion unless this
Medicare does not pay for this Claim/service denied
contractor has issued a local coverage
Category III CPT service because it is considered because
C determination to specifically define the
codes denied as 55A04 N M investigational procedure/treatment is
N/H circumstances by which the service or
experimental and/or experimental in these deemed
procedure is considered reasonable
circumstances. experimental/investigatio
and necessary. Services represented by
nal by the payer.
a category III code approved by the
Part B carrier may be approved by the
fiscal intermediary on an individual
consideration basis.
This/these line(s) were denied by an
B5
automated system for noncovered
16.10 Payment adjusted because
HCPCS 97537, 97545, D services (ex., work-
55A05 O N/A Medicare does not pay for this coverage/program
& 97546 O/H hardening/conditioning, shopping,
item or service. guidelines were not met
community/reintegration training is
or were exceeded
being performed). Beneficiary liable.
2 of 19 04/12/07
Remittance
Med/Tech MSN Code Claim Adjustment
Coverage Area New Code LUAC UAC External Narrative Advice Remark
Ind. MSN Narrative Message Reason Code
Codes
16.26 107
This claim/service was denied because Medicare does not pay for Claim/service adjusted
C the related or qualifying claim/service services or items related to a because the related or
Associated Charges 55A06 N M qualifying claim/service N161
N/H was not paid or identified on the procedure that has
claim. not been approved or billed. was not identified on this
claim.
16.26 107
This claim/service was denied because Medicare does not pay for Claim/service adjusted
D the related or qualifying claim/service services or items related to a because the related or
Associated Charges 55A07 O NA qualifying claim/service N161
O/H was not paid or identified on the procedure that has
claim. not been approved or billed. was not identified on this
claim.
This claim was denied because the 1.7
services to a physician’s office is not a Ambulance services to or from
Ambulance to K 96
55A08 O N/A covered destination and is always a doctor's office are not N157
physician's office O/H Non-covered charges.
denied. Beneficiary responsible, this covered.
has been auto adjudicated.
151
15.1
Payment adjusted because
Multiple or similar This line was denied by an automated The information provided does
the payer deems the
services performed C system because multiple or similar not support the need for this N115
55A09 N M information submitted
on the same day (e.g., N/H services were performed on the same many services M86
does not support this
84466 & 83550) day. or items.
many services.
97
Payment adjusted because
the benefit for this service
41.14
is included in the
I This item/service is not separately This service/item was billed
Inappropriate Billing 55A10 N S payment/allowance for
N/H billable. incorrectly.
another service/procedure
that has already been
adjudicated
3 of 19 04/12/07
Remittance
Med/Tech MSN Code Claim Adjustment
Coverage Area New Code LUAC UAC External Narrative Advice Remark
Ind. MSN Narrative Message Reason Code
Codes
107
21.21
This claim/service was denied because Claim/service adjusted
This service was denied
Services not covered Medicare only covers this service because the related or
I because Medicare only covers
under certain 55A11 N S under certain circumstances. The claim qualifying claim/service
N/H this service under certain
circumstances submitted does not show these was not identified on this
circumstances.
circumstances to be present. claim.
This/these line(s) were denied by an
B5
automated system for noncovered
16.10 Payment adjusted because
HCPCS 97537, 97545, C services (ex., work-
55A12 N M Medicare does not pay for this coverage/program
& 97546 N/H hardening/conditioning, shopping,
item or service. guidelines were not met
community/reintegration training is
or were exceeded
being performed). Provider liable.
B5
This/these line(s) were denied by an 16.10 Payment adjusted because
K
Excluded services 55A13 O NA automated system for noncovered Medicare does not pay for this coverage/program
O/H
services. (Excluded services) item or service. guidelines were not met
or were exceeded
B8
Intermediary downcode for least costly
Claim/service not
alternative. Billed more expensive 17.11
covered/reduced because
Recode 55A14 N/A L N/A service when a less expensive This Item or service cannot be
alternative services were
alternative was available and could be paid as billed.
available, and should
utilized.
have been utilized.
4 of 19 04/12/07
Remittance
Med/Tech MSN Code Claim Adjustment
Coverage Area New Code LUAC UAC External Narrative Advice Remark
Ind. MSN Narrative Message Reason Code
Codes
A service or procedure designated by a
CPT category III code will be
considered investigational and,
therefore, not covered by Medicare by
21.22 55
statutory exclusion unless this
Medicare does not pay for this Claim/service denied
contractor has issued a local coverage
Category III CPT service because it is considered because
D determination to specifically define the
codes denied as 55A15 O NA investigational procedure/treatment is
O/H circumstances by which the service or
experimental and/or experimental in these deemed
procedure is considered reasonable
circumstances. experimental/investigatio
and necessary. Services represented by
nal by the payer.
a category III code approved by the
Part B carrier may be approved by the
fiscal intermediary on an individual
consideration basis.
5 of 19 04/12/07
SNF Denial MSN 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice
Code MSN Narrative Message Code
Ind. Remark Codes
17
Payment adjusted because
requested information was
9.2 not provided or was
Inpatient MEDICAL REVIEW DENIAL
C The item/service was denied because the insufficient/incomplete. N109
Facility 55S00 N M MISSING/INCOMPLETE
N/H information required to make payment 16 N29
(Insuf. Doc.) DOCUMENTATION
was missing. Claim/service lacks
information which is needed
for adjudication.
THIS CLAIM WAS DENIED AFTER
RECORDS WERE REVIEWED AND IT WAS
DETERMINED THAT 13.5 A6
Skilled Nursing
K THE BENEFICIARY WAS NOT ADMITTED You were not admitted to the skilled Prior hospitalization or 30-
Facility 55S01 O NA N109
O/H TO A SNF BEFORE WITHIN 30 DAYS OF nursing facility within 30 days of your day transfer requirement not
(30 day transfer)
THE HOSPITAL DISCHARGE. hospital discharge. met.
13.7
Normally, care is not covered when
116
PAYMENT DENIED. THE ADVANCE provided in a bed that is
Payment denied. The
Skilled Nursing INDEMNIFICATION NOTICE SIGNED BY not certified by Medicare. However,
advance indemnification No pay
Facility I THE PATIENT DID NOT COMPLY WITH since you received covered
55S02 N S notice signed by the patient N109 code of an
(Noncertified N/H REQUIREMENTS. IMPROPER PLACEMENT care, we have decided that you will not
did not comply with "R"
bed) IN A NONCERTIFIED BED. PROVIDER have to pay the facility
requirements.
LIABLE. for anything more than Medicare
coinsurance and noncovered items
13.3 50
Skilled Nursing INFORMATION PROVIDED DOES NOT Information provided does not support These are non-covered
C
Facility (no 55S03 N M SUPPORT THE NEED FOR SKILLED the need for skilled nursing facility services because this is not N109
N/H
skill) NURSING FACILITY CARE. care. deemed a `medical necessity'
by the payer.
6 of 19
SNF Denial MSN 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice
Code MSN Narrative Message Code
Ind. Remark Codes
150
15.8 Payment adjusted because
THE INFORMATION PROVIDED DOES NOT
Skilled Nursing The information provided does not the payer deems the
C SUPPORT THE LEVEL OF SERVICE AS
Facility 55S04 N M support the level of service as shown on information submitted does N72
N/H SHOWN ON THE CLAIM (RUG
(re-rug) the claim. not support this level of
ADJUSTMENT)
service.
16.4A
The provider's determination of
Skilled Nursing
noncoverage is correct. Our records 50
Facility THIS CLAIM WAS DENIED AFTER REVIEW
show that you were informed in writing, These are non-covered
(Demand Bill D BECAUSE THE PROVIDER'S
55S05 O NA before receiving the service, that services because this is not N109
for Part A - O/H DETERMINATION OF NONCOVERAGE IS
Medicare would not pay. You are liable deemed a ‚medical
Beneficiary CORRECT.
for this charge. If you do not agree with necessity‛ by the payer.
Liable)
this statement, you may ask for a review.
B9
Skilled Nursing THIS SERVICE IS NOT COVERED BECAUSE 27.1
K Services are not covered
Facility 55S06 O NA THE BENEFICIARY IS ENROLLED IN This service is not covered because you N109
O/H because the patient is
(Hospice) HOSPICE. are enrolled in a hospice.
enrolled in a hospice.
7 of 19
SNF Denial MSN 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice
Code MSN Narrative Message Code
Ind. Remark Codes
36.2
It appears that you did not know that we
would not pay for this service, so
you are not liable. Do not pay your
THIS CLAIM WAS DENIED BECAUSE IT
provider for this service. If you have
APPEARED THE BENEFICIARY DID NOT 116
paid your provider for this service, you
Skilled Nursing KNOW THAT Payment denied. The
should submit to this office three
Facility THIS SERVICE WAS NOT COVERED. THE advance indemnification
I things: 1) a copy of this notice, 2) your
(Demand Bill 55S07 N S BENEFICIARY IS NOT LIABLE FOR notice signed by the patient N109
N/H provider's bill and, 3) a receipt
for Part A - PAYMENT BECAUSE THE PROVIDER did not comply with
or proof that you have paid the bill. You
Provider Liable) FAILED TO ISSUE A TIMELY OR VALID requirements.
must file your written request
NOTICE.
for payment within 6 months of the date
of this notice. Future services of
this type provided to you will be your
responsibility.
13.2 A6
THIS CLAIM WAS DENIED AFTER IT WAS
Skilled Nursing Skilled Nursing Facility benefits are only Prior Hospitalization or 30-
DETERMINED THAT THE BENEFICIARY
Facility K available after a hospital stay day transfer requirement not
55S08 O N/A DID NOT HAVE A QUALIFYING STAY N109
(No qualifying O/H of at least 3 days. met.
PRIOR TO ADMISSION TO THE SNF.
stay)
8 of 19
Inpatient Denial MSNs 04/12/07
Med/ Remittance
Coverage New MSN Code Claim Adjustment Reason
LUAC UAC Tech External Narrative Advice
Area Code MSN Narrative Message Code
Ind. Remark Codes
THIS CLAIM WAS DENIED AFTER REVIEW 150
AND IT WAS DETERMINED THAT THE 15.8 Payment adjusted because
Inpatient
C DOCUMENTATION DID NOT SUPPORT The information provided does not the payer deems the
(Level of 55I00 N M N109
N /H THE NEED FOR AN INPATIENT LEVEL OF support the level of service as shown on information submitted does
Care)
CARE. the claim. not support this level of
service.
THIS CLAIM WAS DENIED AFTER REVIEW
152
AND IT WAS DETERMINED THAT THE
Inpatient 15.8 Payment adjusted because
DOCUMENTATION DID NOT SUPPORT
(cont. C The information provided does not the payer deems the
55I01 N M THE NEED FOR CONTINUED LEVEL OF N109
level of N /H support the level of service as shown on information submitted does
INPATIENT
care) the claim. not support this length of
CARE.
service.
9 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
THE CLAIM WAS DENIED AFTER REVIEW 17
BECAUSE THE PLAN OF TREATMENT WAS 16.43 Claim/service denied
N109
Plan of I MISSING OR EVIDENCE OF PHYSICIAN This service cannot be approved without because requested
55B00 N S M135
Treatment N/H SUPERVISION/EVALUATION WAS NOT a treatment plan and supervision of a information was not
DOCUMENTED. doctor. (Plan of treatment was not sent) provided or was
insufficient/incomplete.
THIS SERVICE WAS DENIED BECAUSE IN
ACCORDANCE WITH PM AB#03-106
SECTION 1.J.
INTERFACULTY TRANSPORTATION IS A 16.45
I 96
Ambulance 55B02 N S NON COVERED SERVICE AND IS NOT You cannot bill for this item or service N109
N/H Non-covered charges.
BILLABLE separately.
TO FISCAL INTERMEDIARIES OR
BENEFICIARIES.
THIS CLAIM WAS DENIED AFTER
117
RECORDS WERE REVIEWED AND IT WAS
Claim/service
DETERMINED 1.1
denied/reduced because
K THAT THE BENEFICIARY WAS NOT Payment for transportation is allowed
Ambulance 55B03 O NA transportation is only N109
O/H TRANSPORTED TO THE CLOSEST only to the closest facility that can
covered to the closest facility
FACILITY/ORIGINAL FACILITY COULD provide the necessary care.
that can provide the
PROVIDE THE CARE REQUIRED.
necessary care.
THIS CLAIM WAS DENIED AFTER
RECORDS WERE REVIEWED DUE TO
TRANSFER FOR CONVENIENCE. 1.5
K 96
Ambulance 55B04 O NA TRANSPORTATION TO A FACILITY TO BE Transportation to a facility to be closer to N109
O/H Non-covered charges.
CLOSER TO HOME OR FAMILY IS NOT home or family is not covered.
COVERED.
10 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
THIS CLAIM WAS DENIED AFTER IT WAS
DETERMINED THAT THE 1.7
K 96 N109
Ambulance 55B05 O NA BENEFICIARY WAS NOT TAKEN TO AN Ambulance services to or from a doctor’s
O/H Non-covered charges. M77
ACUTE CARE FACILITY. office are not covered.
THIS CLAIM WAS DENIED AFTER
RECORDS WERE REVIEWED BECAUSE 112
MEDICARE WILL NOT 1.8 Payment adjusted as not
K N109
Ambulance 55B06 O NA PAY FOR THE AMBULANCE SERVICE IF This service is denied because you furnished directly to the
O/H N159
THE BENEFICIARY REFUSED TO BE refused to be transported. patient and/or not
TRANSPORTED. documented.
THIS CLAIM WAS DENIED AFTER
RECORDS WERE REVIEWED AND IT WAS 112
1.9
DETERMINED THAT Payment adjusted as not
I Payment for ambulance services does not N109
Ambulance 55B07 N S THE BENEFICIARY WAS NOT IN THE furnished directly to the
N/H include mileage when you were not in N159
AMBULANCE FOR PART/ALL OF THE patient and/or not
the ambulance.
MILEAGE BILLED. documented.
150
1.10 Payment adjusted because
AIR AMBULANCE IS NOT COVERED SINCE
K Air ambulance is not covered since you the payer deems the
Ambulance 55B08 O NA YOU WERE NOT TAKEN TO THE AIRPORT N109
O/H were not taken to the airport by information submitted does
BY AMBULANCE.
ambulance. not support this level of
service.
THIS CLAIM WAS DENIED AFTER REVIEW 150
1.11
AND IT WAS DETERMINED THAT THE Payment adjusted because
The information provided does not
DOCUMENTATION DID NOT SUPPORT the payer deems the
Ambulance 55B09 NA L NA support the need for an air ambulance. N109
THE NEED FOR AIR AMBULANCE. information submitted does
The approved amount is based on
THEREFORE, THE APPROVED AMOUNT IS not support this level of
ground ambulance.
BASED ON GROUND AMBULANCE. service.
11 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
THIS CLAIM WAS DENIED AFTER REVIEW
50
AND IT WAS DETERMINED THAT THE
15.4 These are non-covered
Ambulance K BENEFICIARY COULD HAVE BEEN SAFELY
55B10 O NA The information provided does not services because this is not N109
Coverage O/H TRANSPORTED BY ANOTHER MEANS
support the need for this service or item. deemed a ‚medical
(EX.., AMBULETTE, PRIVATE CAR).
necessity‛ by the payer.
THIS CLAIM WAS ADJUSTED AFTER
RECORDS WERE REVIEWED AND IT WAS
DETERMINED
THAT THE DOCUMENTATION DID NOT
SUPPORT THE LEVEL OF SERVICE BILLED
150
ON THE
15.8 Payment adjusted because
CLAIM (I.E., RECODING THE AMBULANCE
Ambulance The information provided does not the payer deems the N109
55B11 NA L NA SERVICE TO THE LEVEL OF CARE THAT
Down code support the level of service as shown on information submitted does N22
REFLECTS
the claim. not support this level of
THE SERVICES RENDERED, OR
service.
DOWNCODING SERVICES WHEN THE
TITLE OF THE EMERGENCY
MEDICAL PERSONAL CANNOT BE
VALIDATED).
THIS CLAIM WAS DENIED AFTER REVIEW
C BECAUSE MEDICARE DOES NOT PAY FOR 15.14 96
Acupuncture 55B01 N M N109
N/H ACUPUNCTURE. Medicare does not pay for acupuncture. Non-covered charges.
THIS CLAIM WAS DENIED AFTER REVIEW 50
AND IT WAS DETERMINED THAT THE 15.4 These are non-covered
Medical C
55B12 N M DOCUMENTATION DID NOT SUPPORT The information provided does not services because this is not N109
Necessity N/H
MEDICAL NECESSITY. support the need for this service or item. deemed a ‚medical
necessity‛ by the payer.
12 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
THIS CLAIM WAS DENIED AFTER REVIEW
152
AND IT WAS DETERMINED THAT THE 15.1
Payment adjusted because
Medical DOCUMENTATION DID NOT SUPPORT The information provided does not
C the payer deems the
Necessity 55B13 N M THE NECESSITY OF THE FREQUENCY, support the need for this many services N109
N/H information submitted does
(frequency) DURATION OR or items. (Note: Used for unnecessary
not support this length of
AMOUNT OF THE SERVICE(S) BILLED. frequency, duration or amount.)
service.
B22
This claim/service is
THIS CLAIM WAS DENIED AFTER REVIEW
denied/reduced based on the
Medical AND IT WAS DETERMINED THAT THE 16.48
C diagnosis. 50
Necessity (based 55B14 N M DOCUMENTATION DID NOT SUPPORT Medicare does not pay for this item or N109
N/H These are non-covered
on diagnosis) MEDICAL NECESSITY. service for this condition.
services because this is not
deemed a ‚medical
necessity‛ by the payer.
B17
Claim/service denied
THIS CLAIM WAS DENIED AFTER REVIEW
because this service was not
AND IT WAS DETERMINED THAT THE 16.3
I prescribed by a physician,
Physician Order 55B15 N S PHYSICIAN ORDER FOR THE SERVICE The claim did not show that this service N109
N/H not prescribed prior to
BILLED WAS NOT PRESENT. or item was prescribed by your doctor.
delivery, the prescription is
incomplete, or the
prescription is not current.
13 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
SERVICES PROVIDED OFFSITE (OFF
FACILITY GROUNDS) WITHOUT
DOCUMENTATION OF
PHYSICIAN SUPERVISION. (HOSPITAL
SERVICES ONLY). 17.3
Direct Physician I THIS CLAIM WAS DENIED AFTER This service was denied because you did 96 N109
55B16 N S
supervision N/H RECORDS WERE REVIEWED AND IT WAS not receive it under the direct Non-covered charges. M136
DETERMINED THAT supervision of a doctor.
THERE WAS NO DIRECT PHYSICIAN
SUPERVISION OF THE SERVICE
RENDERED.
17
THIS CLAIM WAS DENIED AFTER REVIEW 17.15 Claim/service denied
Physician I BECAUSE THE PHYSICIAN CERTIFICATION This Service cannot be paid unless because requested N109
55B17 N S
Certification N/H WAS INCOMPLETE, INVALID OR ABSENT. certified by your physician every (18, 30, information was not M42
or 60) days. provided or was
insufficient/incomplete.
THIS CLAIM WAS DENIED AFTER REVIEW 58
16.2
AND IT WAS DETERMINED THAT THE Claim/service
This service cannot be paid when
SERVICES denied/reduced because
Facility K provided in this location/facility. (Use N109
55B18 O N/A WERE RENDERED IN A LOCATION NOT treatment was deemed by
Certification O/H this code, as opposed to Denial Reason M77
ELIGIBLE FOR COVERAGE. the payer to have been
Code 57625, if the provider was never
(BENE LIABLE) rendered in an inappropriate
certified to provide the service
or invalid place of service.
185
THIS CLAIM WAS DENIED AFTER REVIEW
THE RENDERING
BECAUSE IT WAS DETERMINED THE 21.2
Non-Eligible K PROVIDER IS NOT
55B19 O N/A PROVIDER The provider of this service is not N109
Provider O/H ELIGIBLE TO PERFORM
WAS INELIGIBLE FOR PAYMENT. eligible to receive Medicare payments.
THE SERVICE BILLED.
14 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
THIS CLAIM WAS DENIED AFTER REVIEW 14.3 114
Services not
K BECAUSE MEDICARE DOES NOT PAY FOR Services or Items not approved by the Procedure/product not N109
approved by the 55B20 O NA
O/H SERVICES NOT APPROVED BY THE FDA . Food and Drug Administration are not approved by the Food and M102
FDA
covered. Drug Administration.
THIS CLAIM WAS DENIED AFTER REVIEW 6.2 114
Drugs not
K BECAUSE MEDICARE DOES NOT PAY FOR Drugs not specifically classified as Procedure/product not
approved by the 55B21 O NA N109
O/H DRUGS NOT APPROVED BY THE FDA. effective by the Food and Drug approved by the Food and
FDA
Administration are not covered. Drug Administration.
21.22 55
THIS SERVICE OR PROCEDURE
Medicare does not pay for this service Claim/service denied
Investigational/ CONSIDERED INVESTIGATIONAL AND,
C because it is considered investigational because procedure/treatment
Experimental 55B22 N M THEREFORE, NOT COVERED BY M102
N/H and/or experimental in these is deemed
Services MEDICARE.
circumstances. experimental/investigational
by the payer.
THIS CLAIM WAS DENIED AFTER REVIEW
AND IT WAS DETERMINED THAT THIS B5
WAS A 16.10 Payment adjusted because
K
Exclusions 55B23 O NA NON-COVERED ITEM/SERVICE. (E.X., SELF- Medicare does not pay for this item or coverage/program N109
O/H
ADMINISTERED DRUGS, ROUTINE EXAMS, service. guidelines were not met or
HEARING AIDS, etc.). were exceeded
THIS CLAIM WAS DENIED AFTER REVIEW
Services does
AND IT WAS FOUND THAT THE
not meet
SERVICE(S) DENIED DID NOT MEET 16.10
Medicare C 96
55B24 N M COVERAGE GUIDELINES. (Ex.., beneficiary Medicare does not pay for this item or N109
guidelines. N/H Non-covered charges.
in PHP receiving 24 care). service.
Services
noncovered.
15 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
THIS CLAIM WAS DENIED AFTER REVIEW B15
AND IT WAS DETERMINED THAT THIS 16.29 Claim/service
Duplication of C
55B25 N M SERVICE IS A DUPLICATION OF ANOTHER Payment is included in another service denied/reduced because this N109
services N/H
SERVICE BEING PROVIDED. you have received. (Duplicate services). procedure/service is not paid
separately.
Inappropriate
THIS CLAIM WAS DENIED BECAUSE THE 17.8
Billing 35
K BENEFIT MAXIMUM HAS BEEN REACHED. Payment was denied because the
(maximum 55B26 O NA Benefit maximum has been N109
O/H (EX.., Inpatient Part B.) maximum benefit allowance has been
benefit has been reached.
reached.
reached)
Inappropriate THIS CLAIM WAS DENIED BECAUSE THIS 109
11.5
Billing services SERVICE NEEDS TO BE BILLED TO Claim not covered by this
I This claim will need to be submitted to
should have 55B27 N S ANOTHER payer/contractor. You must N109
N/H another carrier. (E.g. Regional Durable
billed to another PAYOR/CONTRACTOR (EX. DMERC). send the claim to the correct
Medical Equipment Carrier--DMERC.)
contractor) payer/contractor.
17
Inappropriate THIS CLAIM WAS DENIED BECAUSE THE
Claim/service denied
Billing (did not INFORMATION REQUESTED WAS NOT 9.1
I because requested
receive medical 55B28 N S The information we requested was not
RECEIVED. (EX.., WRONG BENEFICIARY, N109
N/H information was not
records WRONG DOS, OR WRONG SERVICE). received. (Records were not received)
provided or was
requested)
insufficient/incomplete.
150
16.21
THIS CLAIM WAS CHANGED TO REFLECT Payment adjusted because
Inappropriate The procedure code was changed to
THE ACTUAL SERVICE PROVIDED the payer deems the N109
Billing 55B29 NA L NA reflect the actual service rendered. (E.g.,
(EX. OPEN BIOPSY TO CLOSED). information submitted does N22
(recoding) Used when you change open biopsy to
not support this many
closed .)
services.
16 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
THIS CLAIM WAS DENIED AFTER REVIEW
AND IT WAS DETERMINED THAT THE
41.13 B12
Services not I SERVICES
55B30 N S The provider has billed for services/items Services not documented in N109
rendered N/H BILLED WERE NOT DOCUMENTED IN THE
not documented in your record. patient's medical records.
RECORDS.
16
Claim/service lacks
information which is needed
THIS CLAIM WAS DENIED AFTER REVIEW
for adjudication. Additional
AND IT WAS DETERMINED THAT THE
9.2 information is supplied
DOCUMENTATION NEEDED TO MAKE
Insufficient C The item/service was denied because the using remittance advice
55B31 N M PAYMENT WAS MISSING/INCOMPLETE N109
documentation N/H information required to make payment remarks codes whenever
(EX. INCOMPLETE DOCUMENTATION TO
was missing. appropriate. 17
SUPPORT THERAPY UNITS BILLED).
Payment adjusted because
requested information was
not provided or was
insufficient/incomplete.
125
CLAIMS/SERVICE BILLED IN ERROR (EX. PAYMENT ADJUSTED DUE
Inappropriate 17.11
I INAPPROPRIATE UNITS BILLED FOR TO A
billing (billing 55B32 N S This Item or service cannot be paid as M53
N/H HCPC). SUBMISSION/BILLING
errors) billed.
ERROR(S).
151
THIS CLAIM/SERVICES WAS DENIED 15.6 Payment adjusted because
BECAUSE THE INFORMATION PROVIDED The information provided does not the payer deems the
C
ESRD 55B34 N M DOES NOT SUPPORT THE NEED FOR THIS support the need for this many services information submitted does N109
N/H
MANY SERVICES OR ITEMS WITHIN THIS or items within this period of time. not support this many
PERIOD OF TIME. services.
17 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
B15
ESRD (Services 16.32 Claim/service
I MEDICARE DOES NOT PAY SEPARATELY N109
included in the 55B35 N S Medicare does not pay separately for this denied/reduced because this
N/H FOR THIS SERVICE M77
composite rate) service. (E.g., ESRD composite rate.) procedure/service is not paid
separately.
16.41
RNMHCI THIS CLAIM/SERVICE WAS DENIED FOR Payment is being denied because you 125
K
Beneficiary paid 55B36 O NA EXCEPTED SERVICES WHEN THE refused to request reimbursement under Payment adjusted due to a MA47
O/H
out of pocket BENEFICIARY PAID OUT OF POCKET. your Medicare benefits. submission/billing error(s).
36.2
AFTER REVIEW, IT WAS DETERMINED
Part B It appears that you did not know that we 116
THAT ADVANCED BENEFICIARY NOTICE
Non would not pay for this service, so you are Claim/service denied. The
(ABN) OF NONCOVERAGE WAS NOT
Covered/OC32 C not advance indemnification N109
55B37 N M VALID. THEREFORE, THE PROVIDER IS
Charges-- No N/H liable. Do not pay your provider for this notice signed by the patient M25
LIABLE FOR ANY CHARGES INCURRED ON
ABN --Provider service. If you have paid your provider did not comply with
THIS BILL.
Liability for this requirements.
service
16.4A
AFTER REVIEW IT WAS DETERMINED The provider's determination of
THAT THE BENEFICIARY RECEIVED A noncoverage is correct. Our records
50
Part B-- NOT VALID ADVANCED BENEFICIARY NOTICE show that
These are non-covered
LMRP-- D (ABN) OF NONCOVERAGE. THEREFORE, you were informed in writing, before N109
55B38 O NA services because this is not
Beneficiary O/H THE BENEFICIARY IS LIABLE FOR receiving the service, that Medicare M38
deemed a ‚medical
Liability CHARGES INCURRED ON THIS BILL. would
necessity‛ by the payer.
not pay. You are liable for this charge. If
you do not agree with this
statement, you may ask for a review.
18 of 19
Part B Denial MSNs 04/12/07
Med/ Remittance
New MSN Code Claim Adjustment Reason
Coverage Area LUAC UAC Tech External Narrative Advice Remark
Code MSN Narrative Message Code
Ind. Codes
DOCUMENTATION DOES NOT SUPPORT 50
Complex NCD
MEDICAL NECESSITY. 50NCD DENIED. 15.4 These are non-covered
denial D
55B39 O NA MODIFIER GA OR OCCURRENCE CODE 32 The information provided does not services because this is not N109
Beneficiary O/H
IS PRESENT ON CLAIM. BENE IS LIABLE. support the need for this service or item. deemed a "medical
Liable
necessity" by the payer.
DOCUMENTATION DOES NOT SUPPORT
MEDICAL NECESSITY. 51NCD DENIED. 50
Complex NCD MODIFIER GA OR OCCURRENCE CODE 32 15.4 These are non-covered
C
denial -Provider 55B40 N M IS NOT PRESENT ON CLAIM. The information provided does not services because this is not N109
N/H
liable PROVIDER IS LIABLE. support the need for this service or item. deemed a "medical
necessity" by the payer.
THIS CLAIM WAS DENIED AFTER REVIEW
AND IT WAS DETERMINED THAT THE
50
SERVICES
15.4 These are non-covered
Unlicensed Staff C BILLED WERE NOT PROVIDED BY STAFF
55B41 N M The information provided does not services because this is not N109
N/H LICENSED OR OTHERWISE
support the need for this service or item. deemed a "medical
AUTHORIZED (BY THE STATE) TO RENDER
necessity" by the payer.
THE SERVICES.
19 of 19