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["Remark Code","Remark Code Description","835 Remark","835 Remark Description","835 Adj Group","835 Adj Group Description","835 Adj Reason","835 Adj Reason Description"]
["11","THE DIAGNOSIS IS INCONSISTENT WITH THE PROCEDURE.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["110","INVALID SERVICE DATE, GREATER THAN TODAY''S DATE","","","CO","Contractual Obligations","110","Billing date predates service date."]
["111","NOT COVERED UNLESS THE PROVIDER ACCEPTS ASSIGNMENT.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","111","Not covered unless the provider accepts assignment."]
["112","SERVICE NOT FURNISHED DIRECTLY TO THE PATIENT AND/OR NOT DOCUMENTED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","112","Service not furnished directly to the patient and/or not documented."]
["115","PROCEDURE POSTPONED, CANCELED, OR DELAYED.","","","CO","Contractual Obligations","115","Procedure postponed, canceled, or delayed."]
["116","THE ADVANCE INDEMNIFICATION NOTICE SIGNED BY THE PATIENT DID NOT COMPLY WITH REQUIREMENTS.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","116","The advance indemnification notice signed by the patient did not comply with requirements."]
["117","TRANSPORTATION IS ONLY COVERED TO THE CLOSEST FACILITY THAT CAN PROVIDE THE NECESSARY CARE.","","","CO","Contractual Obligations","117","Transportation is only covered to the closest facility that can provide the necessary care."]
["118","ESRD NETWORK SUPPORT ADJUSTMENT.","","","CO","Contractual Obligations","118","ESRD network support adjustment."]
["119","BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["12","THE DIAGNOSIS IS INCONSISTENT WITH THE PROVIDER TYPE.","","","CO","Contractual Obligations","12","The diagnosis is inconsistent with the provider type. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["121","INDEMNIFICATION ADJUSTMENT - COMPENSATION FOR OUTSTANDING MEMBER RESPONSIBILITY.","N432","Alert: Adjustment based on a Recovery Audit.","CO","Contractual Obligations","121","Indemnification adjustment - compensation for outstanding member responsibility."]
["122","PSYCHIATRIC REDUCTION.","","","CO","Contractual Obligations","122","Psychiatric reduction."]
["125","SUBMISSION/BILLING ERROR(S).  AT LEAST ONE REMARK CODE MUST BE PROVIDED (MAY BE COMPRISED OF EITHER THE REMITTANCE ADVICE REMARK CODE OR NCPDP REJECT REASON CODE).","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["128","NEWBORN'S SERVICES ARE COVERED IN THE MOTHER'S ALLOWANCE.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","128","Newborn's services are covered in the mother's Allowance."]
["130","CLAIM SUBMISSION FEE.","","","CO","Contractual Obligations","130","Claim submission fee."]
["131","CLAIM SPECIFIC NEGOTIATED DISCOUNT.","N14","","CO","Contractual Obligations","131","Claim specific negotiated discount."]
["132","PREARRANGED DEMONSTRATION PROJECT ADJUSTMENT.","","","CO","Contractual Obligations","132","Prearranged demonstration project adjustment."]
["134","TECHNICAL FEES REMOVED FROM CHARGES.","","","CO","Contractual Obligations","134","Technical fees removed from charges."]
["135","INTERIM BILLS CANNOT BE PROCESSED.","MA79","Billed in excess of interim rate.","CO","Contractual Obligations","135","Interim bills cannot be processed."]
["136","FAILURE TO FOLLOW PRIOR PAYER''S COVERAGE RULES.","","","OA","OA Other adjustments","136","Failure to follow prior payer's coverage rules. (Use only with Group Code OA)"]
["137","REGULATORY SURCHARGES, ASSESSMENTS, ALLOWANCES OR HEALTH RELATED TAXES.","","","CO","Contractual Obligations","137","Regulatory Surcharges, Assessments, Allowances or Health Related Taxes."]
["138","APPEAL PROCEDURES NOT FOLLOWED OR TIME LIMITS NOT MET.","","","CO","Contractual Obligations","138","Appeal procedures not followed or time limits not met."]
["139","CONTRACTED FUNDING AGREEMENT - SUBSCRIBER IS EMPLOYED BY THE PROVIDER OF SERVICES.","","","CO","Contractual Obligations","139","Contracted funding agreement - Subscriber is employed by the provider of services. Use only with Group Code CO."]
["140","PATIENT/INSURED HEALTH IDENTIFICATION NUMBER AND NAME DO NOT MATCH.","","","OA","OA Other adjustments","140","Patient/Insured health identification number and name do not match."]
["142","MONTHLY MEDICAID PATIENT LIABILITY AMOUNT.","","","OA","OA Other adjustments","142","Monthly Medicaid patient liability amount."]
["143","PORTION OF PAYMENT DEFERRED.","","","CO","Contractual Obligations","143","Portion of payment deferred."]
["144","INCENTIVE ADJUSTMENT, E.G. PREFERRED PRODUCT/SERVICE.","","","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["146","DIAGNOSIS WAS INVALID FOR THE DATE(S) OF SERVICE REPORTED.  PLEASE RESUBMIT CORRECTED CLAIM FOR CONSIDERATION.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["185","THE RENDERING PROVIDER IS NOT ELIGIBLE TO PERFORM THE SERVICE BILLED.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","185","The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["186","LEVEL OF CARE CHANGE ADJUSTMENT.","","","CO","Contractual Obligations","186","Level of care change adjustment."]
["187","HEALTH SAVINGS ACCOUNT PAYMENTS","","","OA","OA Other adjustments","187","Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)"]
["188","THIS PRODUCT/PROCEDURE IS ONLY COVERED WHEN USED ACCORDING TO FDA RECOMMENDATIONS.","","","CO","Contractual Obligations","188","This product/procedure is only covered when used according to FDA recommendations."]
["189","NOT OTHERWISE CLASSIFIED' OR 'UNLISTED' PROCEDURE CODE (CPT/HCPCS) WAS BILLED WHEN THERE IS A SPECIFIC PROCEDURE CODE FOR THIS PROCEDURE/SERVICE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","189","Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service"]
["19","THIS IS A WORK-RELATED INJURY/ILLNESS AND THUS THE LIABILITY OF THE WORKER''S COMPENSATION CARRIER.","","","CO","Contractual Obligations","19","This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier."]
["190","PAYMENT IS INCLUDED IN THE ALLOWANCE FOR A SKILLED NURSING FACILITY (SNF) QUALIFIED STAY.","N19","Procedure code incidental to primary procedure.","CO","Contractual Obligations","190","Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay."]
["191","NOT A WORK RELATED INJURY/ILLNESS AND THUS NOT THE LIABILITY OF THE WORKERS' COMPENSATION CARRIER.","N418","Misrouted claim.  See the payer's claim submission instructions.","OA","OA Other adjustments","19","This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier."]
["193","ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. UPON REVIEW, IT WAS DETERMINED THAT THIS CLAIM WAS PROCESSED PROPERLY.","MA46","Alert: The new information was considered but additional payment will not be issued.","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["194","ANESTHESIA PERFORMED BY THE OPERATING PHYSICIAN, THE ASSISTANT SURGEON OR THE ATTENDING PHYSICIAN.","","","CO","Contractual Obligations","194","Anesthesia performed by the operating physician, the assistant surgeon or the attending physician."]
["197","PRECERTIFICATION/AUTHORIZATION/NOTIFICATION ABSENT.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["198","PRECERTIFICATION/AUTHORIZATION EXCEEDED.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["199","REVENUE CODE AND PROCEDURE CODE DO NOT MATCH.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","199","Revenue code and Procedure code do not match."]
["109","CLAIM NOT COVERED BY THIS PAYER/CONTRACTOR. YOU MUST SEND THE CLAIM TO THE CORRECT PAYER/CONTRACTOR.","N418","Misrouted claim.  See the payer's claim submission instructions.","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["10CC","CRITICAL CARE IS LIMITED TO 10 VISITS PER CONFINEMENT.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["1D","RECALC/CORRECTED BILLING SUBMITTED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["2014","MUE-MEDICAID FAC- HCPCS UNITS FOR LINE ITEM EXCEED MEDICALLY UNLIKELY EDIT MAXIMUM OF XX.  APPROPRIATE MODIFIERS NOT CONSIDERED.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["202","NON-COVERED PERSONAL COMFORT OR CONVENIENCE SERVICES.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","202","Non-covered personal comfort or convenience services."]
["2020","FAC MUE-HPCPS LINE ITEM UNITS EXCEED MEDICALLY UNLIKELY EDIT MAXIMUM OF XX.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["203","DISCONTINUED OR REDUCED SERVICE.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","203","Discontinued or reduced service."]
["2030","FAC MUE-HCPCS TOTAL UNITS EXCEED DAILY ALLOWED MEDICALLY UNLIKELY EDIT MAXIUM OF XX CONTRARY TO CMS POLICY. (LID)","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["204","THIS SERVICE/EQUIPMENT/DRUG IS NOT COVERED UNDER THE PATIENTâ\u0080\u0099S CURRENT BENEFIT PLAN","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["2040","FAC MUE- HCPCS TOTAL UNITS EXCEED DAILY ALLOWED MEDICALLY UNLIKELY EDIT MAXIMUM OF XX BASED ON CLINICAL BENCHMARKS. (LID)","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["206","NATIONAL PROVIDER IDENTIFIER - MISSING.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["207","NATIONAL PROVIDER IDENTIFIER - INVALID FORMAT","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","207","National Provider identifier - Invalid format"]
["1P2Y","SERVICES ARE LIMITED TO ONE EVERY 2 YEARS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["1PP","SERVICE IS LIMITED TO ONCE PER PREGNANCY.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["2","COINSURANCE AMOUNT","","","OA","OA Other adjustments","2","Coinsurance Amount"]
["20","THIS INJURY/ILLNESS IS COVERED BY THE LIABILITY CARRIER.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","20","This injury/illness is covered by the liability carrier."]
["200","EXPENSES INCURRED DURING LAPSE IN COVERAGE","N30","Patient ineligible for this service.","OA","OA Other adjustments","200","Expenses incurred during lapse in coverage"]
["26","EXPENSES INCURRED PRIOR TO COVERAGE.","N30","Patient ineligible for this service.","CO","Contractual Obligations","26","Expenses incurred prior to coverage."]
["27","EXPENSES INCURRED AFTER COVERAGE TERMINATED.","N30","Patient ineligible for this service.","CO","Contractual Obligations","27","Expenses incurred after coverage terminated."]
["3018","EAPG-SERVICE CONSIDERED AN INPATIENT PROCEDURE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3019","NCCI MEDICARE FAC- MUTUALLY EXCLUSIVE PROCEDURE CODE PAIR CONFLICT WITH 'XXXXX' AND IS NOT ALLOWED EVEN IF APPROPRIATE MODIFIER IS PRESENT.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3020","NCCI MEDICARE FAC-PROCEDURE CODE PAIR CONFLICT WITH 'XXXXX' AND IS NOT ALLOWED EVEN IF APPROPRIATE MODIFIER IS PRESENT.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3021","EAPG-MEDICAL VISITS REPORTED WITHOUT MODIFIER -25 OR -27 ON THE SAME DAY AS A SIGNIFICANT PROCEDURE.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3022","EAPG-MODIFIER 'XX' IS INVALID.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3024","EAPG-DATE OF SERVICE IS OUT OF DATE RANGE FOR GROUPER.","N647","Adjusted based on diagnosis-related group (DRG).","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3025","EAPG-INVALID AGE.","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3026","EAPG-INVALID SEX.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3039","NCCI MEDICARE FAC- MUTUALLY EXCLUSIVE PROCEDURE CODE PAIR CONFLICT WITH 'XXXXX' AND IS ALLOWED IF AN APPROPRIATE NCCI MODIFIER IS PRESENT.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3040","NCCI MEDICARE FAC-PROCEDURE CODE PAIR CONFLICT WITH 'XXXXX' AND IS ALLOWED IF AN APPROPRIATE NCCI MODIFIER IS PRESENT.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3041","EAPG-REVENUE CODE 'XXXX' IS INVALID.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3048","EAPG-REVENUE CODE 'XXXX' REQUIRES HCPCS CODE ON SAME LINE.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3074","EAPG-UNITS OF SERVICE GREATER THAN ONE IS INAPPROPRIATE FOR BILATERAL PROCEDURE REPORTED WITH MODIFIER 50.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["34","INSURED HAS NO COVERAGE FOR NEWBORNS.","","","CO","Contractual Obligations","34","Insured has no coverage for newborns."]
["35","LIFETIME BENEFIT MAXIMUM HAS BEEN REACHED.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","35","Lifetime benefit maximum has been reached."]
["3600","EAPG-CORNEAL TRANSPLANT CODED. ENSURE THAT IF APPROPRIATE, ACQUISITION OF THE CORNEAL TISSUE IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3601","EAPG-TRANSFUSION IS CODED. ENSURE THAT BLOOD AND BLOOD PRODUCTS TRANSFUSED ARE ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3602","EAPG-BRACHYTHERAPY IS CODED. ENSURE THAT BRACHYTHERAPY SEEDS OR RADIOELEMENT IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3603","EAPG-NUCLEAR MEDICINE IS CODED. ENSURE THAT RADIOPHARMACEUTICALS USED IN NUCLEAR MEDICINE PROCEDURES ARE ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3604","EAPG-INFUSION THERAPY IS CODED. ENSURE THAT THE SUBSTANCE INFUSED IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3605","EAPG-CHEMOTHERAPY IS CODED. ENSURE THAT CHEMOTHERAPEUTIC AGENTS AND OTHER SUPPORTIVE DRUGS ARE ALSO CODED.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3606","EAPG-VACCINATION IS CODED. ENSURE THAT THE VACCINE ADMINISTERED IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3607","EAPG-INJECTION IS CODED. ENSURE THAT THE SUBSTANCE INJECTED IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3609","EAPG-LENS IMPLANT IS CODED. ENSURE THAT THE INTRAOCULAR LENS IS ALSO CODED IF APPLICABLE.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3610","EAPG-NEUROSTIMULATOR IMPLANTATION IS CODED. ENSURE THAT THE NEUROSTIMULATOR IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3611","EAPG-INSERTION OF PROSTHESIS IS CODED. ENSURE THAT THE PENILE PROSTHESIS IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3613","EAPG-RADIOLOGY PROCEDURE WITH CONTRAST IS CODED. ENSURE THAT THE CONTRAST MATERIAL IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3614","EAPG-INTERVENTIONAL RADIOLOGY PROCEDURE IS CODED. ENSURE THAT THE SURGICAL INTERVENTION IS ALSO CODED.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3615","EAPG-A 3D RENDERING RADIOLOGY PROCEDURE IS CODED. ENSURE THAT THE BASE RADIOLOGY PROCEDURE IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3617","EAPG-SURGICAL PLACEMENT OF DEVICE FOR CLINICAL BRACHYTHERAPY HAS BEEN CODED.  ENSURE THAT APPLICATION OF BRACHYTHERAPY SOURCE IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3618","EAPG-SKIN SUBSTITUTE IS CODED.  ENSURE THAT APPLICATION OF THE SKIN SUBSTITUTE IS ALSO CODED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["31","PATIENT CANNOT BE IDENTIFIED AS OUR INSURED.","","","PR","PR Patient Responsibility","31","Patient cannot be identified as our insured."]
["33","INSURED HAS NO DEPENDENT COVERAGE.","","","CO","Contractual Obligations","33","Insured has no dependent coverage."]
["3319","EAPG- THIS IS MUTUALLY EXCLUSIVE CODE IS PAIRED WITH ANOTHER CODE TO TRIGGER EDIT 3019.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3320","EAPG- THIS COLUMN 1 CODE IS PAIRED WITH A COLUMN 2 CODE TO TRIGGER EDIT 3020.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3339","EAPG- THIS MUTUALLY EXCLUSIVE CODE IS PAIRED WITH ANOTHER CODE TO TRIGGER EDIT 3039.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3340","EAPG- THIS COLUMN 1 CODE IS PAIRED WITH COLUMN 2 CODE TO TRIGGER EDIT 3040.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["5","THE PROCEDURE CODE/BILL TYPE IS INCONSISTENT WITH THE PLACE OF SERVICE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["50","THESE ARE NON-COVERED SERVICES BECAUSE THIS IS NOT DEEMED A 'MEDICAL NECESSITY' BY THE PAYER.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["53","SERVICES BY AN IMMEDIATE RELATIVE OR A MEMBER OF THE SAME HOUSEHOLD ARE NOT COVERED.","N30","Patient ineligible for this service.","OA","OA Other adjustments","53","Services by an immediate relative or a member of the same household are not covered."]
["54","MULTIPLE PHYSICIANS/ASSISTANTS ARE NOT COVERED IN THIS CASE .","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["65D","APPEAL DENIED. APPEAL RECEIVED MORE THAN 65 DAYS FROM DATE OF PAYMENT OR DENIAL","","","CO","Contractual Obligations","286","Appeal time limits not met"]
["65RC","RECONSIDERATION REQUEST DENIED; REQUEST RECEIVED MORE THAN 65 DAYS FROM DATE OF PAYMENT OR DENIAL","","","CO","Contractual Obligations","286","Appeal time limits not met"]
["66","BLOOD DEDUCTIBLE.","","","OA","OA Other adjustments","66","Blood Deductible."]
["69","DAY OUTLIER AMOUNT.","","","CO","Contractual Obligations","69","Day outlier amount."]
["70","COST OUTLIER - ADJUSTMENT TO COMPENSATE FOR ADDITIONAL COSTS.","N432","Alert: Adjustment based on a Recovery Audit.","CO","Contractual Obligations","70","Cost outlier - Adjustment to compensate for additional costs."]
["3","CO-PAYMENT AMOUNT","","","PR","PR Patient Responsibility","3","Co-payment Amount"]
["30","INFO NOT REC'D WITHIN 30 DAYS, PATIENT NOT RESPONSIBLE","N432","Alert: Adjustment based on a Recovery Audit.","CO","Contractual Obligations","226","Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["3005","EAPG-EXTERNAL CAUSE OF MORBIDITY CODE CANNOT BE USED AS PRIMARY OR PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3006","EAPG-INVALID PROCEDURE CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["4PYR","SERVICES ARE LIMITED TO 4 PER YEAR","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["837","CLAIM HAS BEEN REPROCESSED FOR SYSTEM RECONCILIATION, NOT IN RESPONSE TO INQUIRY OR RESUBMISSION BY PROVIDER.","N377","Payment based on a processed replacement claim.","CO","Contractual Obligations","B13","Previously paid. Payment for this claim/service may have been provided in a previous payment."]
["85","PATIENT INTEREST ADJUSTMENT (USE ONLY GROUP CODE PR)","N14","","PR","PR Patient Responsibility","85","Patient Interest Adjustment (Use Only Group code PR)"]
["95","PLAN PROCEDURES NOT FOLLOWED.","N182","This claim/service must be billed according to the schedule for this plan.","CO","Contractual Obligations","95","Plan procedures not followed."]
["96","NON-COVERED CHARGE(S). AT LEAST ONE REMARK CODE MUST BE PROVIDED (MAY BE COMPRISED OF EITHER THE REMITTANCE ADVICE REMARK CODE OR NCPDP REJECT REASON CODE.)","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["97","THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED.","N19","Procedure code incidental to primary procedure.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["51","THESE ARE NON-COVERED SERVICES BECAUSE THIS IS A PRE-EXISTING CONDITION","","","CO","Contractual Obligations","51","These are non-covered services because this is a pre-existing condition. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["02EA","EAPG CLAIM NOT PROCESSED; INVALID CLAIM FROM OR THROUGH DATE, OR OUTSIDE SUPPORTED PERIOD.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["03EA","EAPG CLAIM NOT PROCESSED; SINGLE VISIT OPTION NOT SELECTED IN SCHEDULE AND LINE DATE NOT WITHIN FROM/THROUGH DATES OR INVALID.","N182","This claim/service must be billed according to the schedule for this plan.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["04EA","EAPG CLAIM NOT PROCESSED; CLAIM HAS NO VALID VISITS.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["05EA","EAPG CLAIM NOT PROCESSED; NO PRIMARY DIAGOSNIS CODE.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["1","DEDUCTIBLE AMOUNTS","","","OA","OA Other adjustments","1","Deductible Amount"]
["10","THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT''S GENDER.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["100","PAYMENT MADE TO PATIENT/INSURED/RESPONSIBLE PARTY/EMPLOYER.","","","OA","OA Other adjustments","100","Payment made to patient/insured/responsible party."]
["100D","DME SERVICE EXCEEDS QUANTITIY LIMITS. SVC LIMITED TO 100 PER 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["102","MAJOR MEDICAL ADJUSTMENT.","","","CO","Contractual Obligations","102","Major Medical Adjustment."]
["103","PROVIDER PROMOTIONAL DISCOUNT (E.G., SENIOR CITIZEN DISCOUNT).","","","CO","Contractual Obligations","103","Provider promotional discount (e.g., Senior citizen discount)."]
["104","MANAGED CARE WITHHOLDING.","","","CO","Contractual Obligations","104","Managed care withholding."]
["105","TAX WITHHOLDING.","","","CO","Contractual Obligations","105","Tax withholding."]
["107","THE RELATED OR QUALIFYING CLAIM/SERVICE WAS NOT IDENTIFIED ON THIS CLAIM.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","107","The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["108","RENT/PURCHASE GUIDELINES WERE NOT MET.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","108","Rent/purchase guidelines were not met. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["147","PROVIDER CONTRACTED/NEGOTIATED RATE EXPIRED OR NOT ON FILE.","","","CO","Contractual Obligations","147","Provider contracted/negotiated rate expired or not on file."]
["148","INFORMATION FROM ANOTHER PROVIDER WAS NOT PROVIDED OR WAS INSUFFICIENT/INCOMPLETE.:","N181","Additional information is required from another provider involved in this service.","CO","Contractual Obligations","148","Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["149","LIFETIME BENEFIT MAXIMUM HAS BEEN REACHED FOR THIS SERVICE/BENEFIT CATEGORY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","149","Lifetime benefit maximum has been reached for this service/benefit category."]
["15","THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","15","The authorization number is missing, invalid, or does not apply to the billed services or provider."]
["150","PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS LEVEL OF SERVICE.","","","CO","Contractual Obligations","150","Payer deems the information submitted does not support this level of service."]
["151","PAYMENT ADJUSTED BECAUSE THE PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS MANY/FREQUENCY OF SERVICES.","N432","Alert: Adjustment based on a Recovery Audit.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["152","PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS LENGTH OF SERVICE.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","152","Payer deems the information submitted does not support this length of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["153","PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS DOSAGE.","","","CO","Contractual Obligations","153","Payer deems the information submitted does not support this dosage."]
["154","PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS DAY'S SUPPLY.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","154","Payer deems the information submitted does not support this day's supply."]
["155","PATIENT REFUSED THE SERVICE/PROCEDURE.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","155","Patient refused the service/procedure."]
["157","SERVICE/PROCEDURE WAS PROVIDED AS A RESULT OF AN ACT OF WAR.","","","CO","Contractual Obligations","157","Service/procedure was provided as a result of an act of war."]
["158","SERVICE/PROCEDURE WAS PROVIDED OUTSIDE OF THE UNITED STATES.","","","CO","Contractual Obligations","158","Service/procedure was provided outside of the United States."]
["159","SERVICE/PROCEDURE WAS PROVIDED AS A RESULT OF TERRORISM.","","","CO","Contractual Obligations","159","Service/procedure was provided as a result of terrorism."]
["A27K","MAXIMUM BENEFIT OF $27,000 PER CALENDAR YEAR HAS BEEN EXHAUSTED","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["A36K","MAXIMUM BENEFIT OF $36,000 PER CALENDAR YEAR HAS BEEN EXHAUSTED","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["16","CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION.  AT LEAST ONE REMARK CODE MUST BE PROVIDED (MAY BE COMPRISED OF EITHER THE REMITTANCE ADVICE REMARK CODE OR NCPDP REJECT REASON CODE).","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["160","INJURY/ILLNESS WAS THE RESULT OF AN ACTIVITY THAT IS A BENEFIT EXCLUSION.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","160","Injury/illness was the result of an activity that is a benefit exclusion."]
["162","STATE-MANDATED REQUIREMENT FOR PROPERTY AND CASUALTY, SEE CLAIM PAYMENT REMARKS CODE FOR SPECIFIC EXPLANATION.","","","CO","Contractual Obligations","P7","The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. To be used for Property and Casualty only."]
["163","ATTACHMENT REFERENCED ON THE CLAIM WAS NOT RECEIVED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["164","ATTACHMENT REFERENCED ON THE CLAIM WAS NOT RECEIVED IN A TIMELY FASHION.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","164","Attachment/other documentation referenced on the claim was not received in a timely fashion."]
["165","REFERRAL ABSENT OR EXCEEDED.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","165","Referral absent or exceeded."]
["24","CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN.","","","CO","Contractual Obligations","24","Charges are covered under a capitation agreement/managed care plan."]
["245","PROVIDER NOT ELIGIBLE TO RECEIVE PAYMENT PER HFS OIG GUIDANCE.","","","CO","Contractual Obligations","299","The billing provider is not eligible to receive payment for the service billed."]
["24A","CHARGES ARE COVERED UNDER A FQHC APM CAPITATION AGREEMENT/MANAGED CARE PLAN","","","CO","Contractual Obligations","24","Charges are covered under a capitation agreement/managed care plan."]
["3101","EAPG-INVALID DIAGNOSIS CODE, 4TH OR 5TH DIGIT REQUIRED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3102","EAPG-INVALID DIAGNOSIS CODE.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3103","EAPG-AGE CONFLICT-DIAGNOSIS CONSIDERED ONLY FOR NEWBORNS, AGE <1 YEAR.","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3104","EAPG- AGE CONFLICT -DIAGNOSIS CONSIDERED ONLY FOR PEDIATRIC PATIENTS, AGE <18 YEARS.","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3105","EAPG- AGE CONFLICT-DIAGNOSIS CONSIDERED ONLY FOR MATERNITY, FEMALES 12-55 YEARS.","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3106","EAPG- AGE CONFLICT -DIAGNOSIS CONSIDERED ONLY FOR ADULTS, AGE 15 AND UP.","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3107","EAPG- SEX CONFLICT-DIAGNOSIS CODE IS ONLY VALID FOR MALE PATIENTS.  MAY REQUIRE CONDITION CODE 45 TO ADDRESS AMBIGUOUS GENDER.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3108","EAPG- SEX CONFLICT-DIAGNOSIS CODE IS ONLY VALID FOR FEMALE PATIENTS.  MAY REQUIRE CONDITION CODE 45 TO ADDRESS AMBIGUOUS GENDER.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3111","EAPG- SEX CONFLICT-PROCEDURE ONLY VALID FOR MALE PATIENTS.  MAY REQUIRE CONDITION CODE 45 AND MODIFIER KX TO ADDRESS AMBIGUOUS GENDER.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3112","EAPG- SEX CONFLICT-PROCEDURE ONLY VALID FOR FEMALE PATIENTS.  MAY REQUIRE CONDITION CODE 45 AND MODIFIER KX TO ADDRESS AMBIGUOUS GENDER.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3115","EAPG-FROM DATE IS INVALID OR BLANK. THIS IS A REQUIRED FIELD.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3116","EAPG-THROUGH DATE IS INVALID OR BLANK. THIS IS A REQUIRED FIELD.","M59","Missing/incomplete/invalid 'to' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3117","EAPG-LINE ITEM SERVICE DATE IS INVALID OR BLANK. THIS IS A REQUIRED FIELD.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3118","EAPG-LINE ITEM SERVICE DATE IS NOT WITHIN THE FROM-THROUGH DATES.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3119","EAPG-FROM DATE CANNOT BE AFTER THROUGH DATE.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3120","EAPG-TERMINATED BILATERAL PROCEDURE. DO NOT USE MODIFIER -50 WHEN REPORTING A TERMINATED PROCEDURE.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3121","EAPG-TERMINATED PROCEDURE WITH UNITS GREATER THAN ONE. DO NOT USE MULTIPLE UNITS WHEN REPORTING A TERMINATED PROCEDURE.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3122","EAPG-PRIMARY OR PRINCIPAL DIAGNOSIS CODE IS BLANK; MUST BE A VALID CODE.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3123","EAPG-TYPE OF BILL IS INVALID, MAY AFFECT CLAIM PROCESSING.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3124","EAPG-DUPLICATE LAB OR PATHOLOGY CODE. ADD MODIFIER 59, 91, XE, XP, XS, OR XU IF DOCUMENTATION SUPPORTS USE. OTHERWISE DUPLICATE CODE MAY NOT BE PAID.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["3128","EAPG-DUPLICATE RADIOLOGY CODE. ADD MODIFIER IF DOCUMENTATION SUPPORTS USE TO DIFFERENTIATE SERVICES. OTHERWISE DUPLICATE CODE MAY NOT BE PAID.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["3129","EAPG-PRESENCE OF AN ANATOMIC SITE MODIFIER ON THIS OR CODE(S) XXXXX, XXXXX, XXXXX IS SUPPRESSING NCCI EDIT. CHECK DOCUMENTATION TO DETERMINE WHETHER BOTH CODE PAIR(S) CAN BE BILLED OR AN ADDITIONAL SITE MODIFIER ADDED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3130","EAPG-PRESENCE OF THE SAME ANATOMIC SITE MODIFIER ON THIS AND CODE(S) XXXXX, XXXXX, XXXXX IS SUPPRESSING NCCI EDIT. CHECK DOCUMENTATION TO VERIFY USE OF SAME MODIFIER. OTHERWISE ONE OF THE CODES MAY NOT BE PAID.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3132","EAPG-INHERENT BILATERAL CODE, REPORT CODE ONCE.  DO NOT REPORT WITH MODIFIER -50.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3133","EAPG-MULTIPLE E/M CODES SAME DAY WITHOUT MODIFIER -27. EVALUATE ADDING TO SECOND AND SUBSEQUENT E/M CODES.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3135","EAPG-INHERENT BILATERAL PROCEDURE. CONSIDER REMOVING MODIFIER -50 FROM THIS CODE.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3143","EAPG-DUPLICATE LAB OR PATHOLOGY CODE.  ADD MODIFIER 59, 91, XE, XP, XS, OR XU IF DOCUMENTATION SUPPORTS USE.  OTHERWISE DUPLICATE CODE MAY NOT BE PAID.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["3144","EAPG-ADD-ON CODE REPORTED WITHOUT BASE PROCEDURE XXXXX, XXXXX-XXXXX.","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["3145","EAPG-MODIFIER -25 IS REPORTED FOR A MEDICAL VISIT EAPG WITH NO SIGNIFICANT PROCEDURE EAPG PRESENT FOR THE SAME DATE OF SERVICE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3162","EAPG-DIAGNOSIS CODE 'XXXXX' IS REPORTED.  ENSURE THAT MODIFIER PA, PB, OR PC IS ALSO REPORTED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3163","EAPG-MODIFIER PA, PB, OR PC IS REPORTED.  ENSURE THAT DIAGNOSIS CODE 'XXXXX, XXXXX, OR XXXXX' IS ALSO REPORTED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3170","EAPG-DUPLICATE DIAGNOSTIC OR THERAPEUTIC PROCEDURES.  ADD MODIFIER IF DOCUMENTATION SUPPORTS USE TO DIFFERENTIATE SERVICES.  OTHERWISE DUPLICATE CODE MAY NOT BE PAID.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["3171","EAPG-MODIFIER REPORTED FOR THIS CODE IS SUPPRESSING NCCI EDIT WHEN PAIRED WITH XXXXX.  REVIEW DOCUMENTATION TO DETERMINE IF MODIFIER SHOULD BE REPORTED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3172","EAPG-REVENUE CODE REPORTED REQUIRES REASON FOR VISIT DIAGNOSIS CODE.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["3178","EAPG-MODIFIER 59 IS REPORTED. CONSIDER REPORTING MODIFIER XE, XP, XS, OR XU INSTEAD IF MORE APPROPRIATE.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["32","CLAIM DENIED AS PATIENT CANNOT BE IDENTIFIED AS OUR INSURED.","","","PR","PR Patient Responsibility","31","Patient cannot be identified as our insured."]
["39","SERVICES DENIED AT THE TIME AUTHORIZATION/PRE-CERTIFICATION WAS REQUESTED.","","","CO","Contractual Obligations","39","Services denied at the time authorization/pre-certification was requested."]
["170","PAYMENT IS DENIED WHEN PERFORMED/BILLED BY THIS TYPE OF PROVIDER.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["171","PAYMENT IS DENIED WHEN PERFORMED/BILLED BY THIS TYPE OF PROVIDER IN THIS TYPE OF FACILITY.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","171","Payment is denied when performed/billed by this type of provider in this type of facility. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["172","PAYMENT IS ADJUSTED WHEN PERFORMED/BILLED BY A PROVIDER OF THIS SPECIALTY","","","CO","Contractual Obligations","172","Payment is adjusted when performed/billed by a provider of this specialty. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["173","SERVICE WAS NOT PRESCRIBED BY A PHYSICIAN.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","173","Service/equipment was not prescribed by a physician."]
["174","SERVICE WAS NOT PRESCRIBED PRIOR TO DELIVERY.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","174","Service was not prescribed prior to delivery."]
["175","PRESCRIPTION IS INCOMPLETE.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","175","Prescription is incomplete."]
["176","PRESCRIPTION IS NOT CURRENT.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","176","Prescription is not current."]
["177","PATIENT HAS NOT MET THE REQUIRED ELIGIBILITY REQUIREMENTS.","N30","Patient ineligible for this service.","CO","Contractual Obligations","177","Patient has not met the required eligibility requirements."]
["178","PATIENT HAS NOT MET THE REQUIRED SPEND DOWN REQUIREMENTS.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","178","Patient has not met the required spend down requirements."]
["179","PATIENT HAS NOT MET THE REQUIRED WAITING REQUIREMENTS.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","179","Patient has not met the required waiting requirements. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["167","THIS (THESE) DIAGNOSIS(ES) IS (ARE) NOT COVERED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","167","This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["168","SERVICE(S) HAVE BEEN CONSIDERED UNDER THE PATIENT'S MEDICAL PLAN. BENEFITS ARE NOT AVAILABLE UNDER THIS DENTAL PLAN.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","168","Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan."]
["169","ALTERNATE BENEFIT HAS BEEN PROVIDED.","","","OA","OA Other adjustments","169","Alternate benefit has been provided."]
["8","THE PROCEDURE CODES IS INCONSISTENT WITH THE PROVIDER TYPE/SPECIALTY (TAXONOMY).","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["180","PATIENT HAS NOT MET THE REQUIRED RESIDENCY REQUIREMENTS.","","","CO","Contractual Obligations","180","Patient has not met the required residency requirements."]
["180D","APPEAL DENIED.  APPEAL RECEIVED MORE THAN 180 DAYS FROM DATE OF PAYMENT OR DENIAL.","","","CO","Contractual Obligations","138","Appeal procedures not followed or time limits not met."]
["181","The billed Procedure code/Revenue Code/DRG is invalid/missing.","N56","Procedure code billed is not correct/valid for the services billed or the date of service billed.","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["183","THE REFERRING PROVIDER IS NOT ELIGIBLE TO REFER THE SERVICE BILLED.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","183","The referring provider is not eligible to refer the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["184","THE PRESCRIBING/ORDERING PROVIDER IS NOT ELIGIBLE TO PRESCRIBE/ORDER THE SERVICE BILLED.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","184","The prescribing/ordering provider is not eligible to prescribe/order the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["208","NATIONAL PROVIDER IDENTIFIER - NOT MATCHED.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","208","National Provider Identifier - Not matched."]
["209","PER REGULATORY OR OTHER AGREEMENT. THE PROVIDER CANNOT COLLECT THIS AMOUNT FROM THE PATIENT. HOWEVER, THIS AMOUNT MAY BE BILLED TO SUBSEQUENT PAYER. REFUND TO PATIENT IF COLLECTED.","","","OA","OA Other adjustments","209","Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA)"]
["20CC","CRITICAL CARE IS LIMITED TO 20 VISITS PER CONFINEMENT.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["21","THIS INJURY/ILLNESS IS THE LIABILITY OF THE NO-FAULT CARRIER.","N724","Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.","CO","Contractual Obligations","21","This injury/illness is the liability of the no-fault carrier."]
["210","PAYMENT ADJUSTED BECAUSE PRE-CERTIFICATION/AUTHORIZATION NOT RECEIVED IN A TIMELY FASHION","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","210","Payment adjusted because pre-certification/authorization not received in a timely fashion"]
["211","NATIONAL DRUG CODES (NDC) NOT ELIGIBLE FOR REBATE, ARE NOT COVERED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","211","National Drug Codes (NDC) not eligible for rebate, are not covered."]
["212","ADMINISTRATIVE SURCHARGES ARE NOT COVERED","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","212","Administrative surcharges are not covered"]
["213","NON-COMPLIANCE WITH THE PHYSICIAN SELF REFERRAL PROHIBITION LEGISLATION OR PAYER POLICY.","N475","Missing completed referral form.","CO","Contractual Obligations","213","Non-compliance with the physician self referral prohibition legislation or payer policy."]
["216","BASED ON THE FINDINGS OF A REVIEW ORGANIZATION","","","CO","Contractual Obligations","216","Based on the findings of a review organization"]
["2220","MUE-MEDICAID FAC- PROCEDURE CODE PAIR CONFLICT WITH ''XXXXX'' AND IS NOT ALLOWED EVEN IF APPROPRIATE MODIFIER IS PRESENT","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["224","PATIENT IDENTIFICATION COMPROMISED BY IDENTITY THEFT. IDENTITY VERIFICATION REQUIRED FOR PROCESSING THIS AND FUTURE CLAIMS.","","","CO","Contractual Obligations","224","Patient identification compromised by identity theft. Identity verification required for processing this and future claims."]
["2240","NCCI MEDICAID FAC- PROCEDURE CODE PAIR CONFLICT WITH ''XXXXX'' AND IS ALLOWED IF AN APPROPRIATE NCCI MODIFIER IS PRESENT.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["23","THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS.","","","OA","OA Other adjustments","23","The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)"]
["3DI","MUST BILL BASE RADIOLOGY PROCEDURE WITH 3D IMAGING","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["40","CHARGES DO NOT MEET QUALIFICATIONS FOR EMERGENT/URGENT CARE.","","","CO","Contractual Obligations","40","Charges do not meet qualifications for emergent/urgent care. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["44","PROMPT-PAY DISCOUNT.","","","CO","Contractual Obligations","44","Prompt-pay discount."]
["45","CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT. (USE GROUP CODES PR OR CO DEPENDING ON LIABILITY).","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["55EA","EAPG CLAIM LINE ACTION- NO PAYMENT. INVALID PROCEDURE, CANNOT BE BLANK OR NO EAPG REIMBURSEMENT FOR THIS CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["56","PROCEDURE/TREATMENT HAS NOT BEEN DEEMED ''PROVEN TO BE EFFECTIVE'' BY THE PAYER.","","","CO","Contractual Obligations","56","Procedure/treatment has not been deemed 'proven to be effective' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["59","PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES. (FOR EXAMPLE MULTIPLE SURGERY OR DIAGNOSTIC IMAGING, CONCURRENT ANESTHESIA.)","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["6","THE PROCEDURE/REVENUE CODE IS INCONSISTANT WITH THE PATIENT'S AGE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["60","CHARGES FOR OUTPATIENT SERVICES ARE NOT COVERED WHEN PERFORMED WITHIN A PERIOD OF TIME PRIOR TO OR AFTER INPATIENT SERVICES.","","","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["6003","APPLIED TO THE INDIVIDUAL IN-NETWORK DEDUCTIBLE.","","","OA","OA Other adjustments","1","Deductible Amount"]
["6008","APPLIED TO THE FAMILY IN-NETWORK DEDUCTIBLE.","","","OA","OA Other adjustments","1","Deductible Amount"]
["6011","APPLIED TO YOUR INDIVIDUAL IN-NETWORK OUT OF POCKET.","","","OA","OA Other adjustments","2","Coinsurance Amount"]
["6012","APPLIED TO YOUR IN-NETWORK FAMILY OUT OF POCKET.","","","OA","OA Other adjustments","2","Coinsurance Amount"]
["60D","APPEAL DENIED. APPEAL RECEIVED MORE THAN 60 DAYS FROM DATE OF PAYMENT OR DENIAL","","","CO","Contractual Obligations","286","Appeal time limits not met"]
["BPR","INCLUDED IN BPR, PER DIEM OR BUNDLE.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["BRAC","SERVICES REQUIRE BRACHYTHERAPY SEEDS/RADIOELEMENTS TO BE BILLED","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["BRC","BRACHYTHERAPY PROCDURE FOR THE APPLICATION MUST BE BILLED","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["BTD","OTHER MSO LIABILITY.","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["C100","$100 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C110","$110 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C120","$120 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C128","$128 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C135","$135 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C140","$140 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C150","$150 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C200","$200 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C400","$400 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C500","$500 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C750","$750 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C800","$800 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C825","$825 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["61","PENALTY FOR FAILURE TO OBTAIN SECOND SURGICAL OPINION.","","","CO","Contractual Obligations","61","Adjusted for failure to obtain second surgical opinion"]
["74","INDIRECT MEDICAL EDUCATION ADJUSTMENT.","","","CO","Contractual Obligations","74","Indirect Medical Education Adjustment."]
["A38","HCPCS CODE NOT ELIGIBLE TO BE BILLED WITH REVENUE CODE PER HFS GUIDELINES.","","","CO","Contractual Obligations","199","Revenue code and Procedure code do not match."]
["AB","ADJUSTMENT MADE TO ALLOWED AMOUNT, TO DEDUCT PAYMENT ON PRIOR CLAIM WHICH IS INCLUDED IN BENEFIT ON CURRENT CLAIM","N10","Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.","OA","OA Other adjustments","169","Alternate benefit has been provided."]
["AL","APPEAL DENIED. LETTER SENT UNDER SEPARATE COVER.","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["A5","MEDICARE CLAIM PPS CAPITAL COST OUTLIER AMOUNT.","","","CO","Contractual Obligations","A5","Medicare Claim PPS Capital Cost Outlier Amount."]
["A6","PRIOR HOSPITALIZATION OR 30 DAY TRANSFER REQUIREMENT NOT MET.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","A6","Prior hospitalization or 30 day transfer requirement not met."]
["A7","PRESUMPTIVE PAYMENT ADJUSTMENT","N432","Alert: Adjustment based on a Recovery Audit.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["AMBV","CLAIM HAS BEEN MISDIRECTED FOR NON-EMERGENCY AMBULANCE SERVICES.","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["CHEM","CHEMO ADMIN MUST BE BILLED WITH APPROPRIATE CHEMO DRUG","N349","The administration method and drug must be reported to adjudicate this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CHIP","MAXIMUM FREQUENCY REACHED FOR CHIRO SERVICES.","N640","Exceeds number/frequency approved/allowed within time period.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["CHLD","CLAIM HAS BEEN PUT ON ADMINISTRATIVE HOLD. CLAIM WILL BE CONSIDERED ONCE THE HOLD HAS BEEN REMOVED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["CHNA","SERVICES DENIED.  CHIROPRACTIC NOT AUTHORIZED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["CLIN","RENDERING PROVIDER MUST PROVIDE CLINICAL INFORMATION FOR THESE SERVICES.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CNC","CPT CODES BILLED ARE NOT COMPATIBLE WITH THE REVENUE CODES.  PLEASE SUBMIT A CORRECTED BILL.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CNP","CODE NOT ALLOWABLE PER PROVIDER CONTRACTED FEE SCHEDULE","N448","This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["COBF","A COMPLETED COORDINATION OF BENEFITS FORM MUST BE SUBMITTED BY MEMBER TO PROCESS THIS CLAIM.","N479","Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).","OA","OA Other adjustments","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["COR","BENEFITS WERE COORDINATED WITH THE PRIMARY HEALTH CARE PLAN.","","","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["COSE","COSMETIC SERVICES/SURGERY ARE NOT COVERED UNDER THE PLAN.","N383","Not covered when deemed cosmetic.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["CP10","$10 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP15","$15 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP18","$18 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP20","$20 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP23","$23 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP24","$24 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP25","$25 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP26","$26 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP30","$30 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP33","$33.60 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP35","$35 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP37","$37 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP38","$38 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP4","$4 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP40","$40 PATIENT COPAY AMOUNT","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP45","$45 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP5","$5 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP50","$50 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP55","$55 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP60","$60 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP69","$69 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP70","$70 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP75","$75 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP8","$8 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP80","$80 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP85","$85 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CP9","$9 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["CPPD","CLAIM PROCESSED UNDER PLAN DIRECTED CARE","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["CPTR","CPT CODE ONLY PAYABLE WHEN BILLED WITH REV CODE 0657","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CRC","CLAIM HAS BEEN ADJUSTED DUE TO PREVIOUS PAYMENT MADE ON CLAIM(S) PRIOR TO THIS CORRECTED CLAIM HAVING BEEN RECEIVED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["CSA","CORNEAL PROCEDURES NOT COVERED UNLESS BILLED WITH PROCEDURE INDICATING ACQUISITION OF THE CORNEAL TISSUE","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","B15","This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["CSCB","NO OTHER INSURANCE COVERAGE FOR DATE OF SERVICE.  CLAIMS HAVE BEEN REPROCESSED.","N245","Incomplete/invalid plan information for other insurance.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["DFUD","A $12.00 DISPENSING FEE IS ALLOWED FOR 340B ENROLLED PROVIDERS WHEN BILLED WITH THE \"UD\" MODIFIER.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["DHHS","DHHS RESPONSIBILITY.  FOR PAYMENT, PLEASE SUBMIT CLAIM TO DHHS VIA FAX AT 1-866-652-7253.","N418","Misrouted claim.  See the payer's claim submission instructions.","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["D02","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DLTC","NON COVERED LTC REV CODE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DM01","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 90 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM03","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 3 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DM04","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 4 EVERY 60 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DM1","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMTIED TO 1 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM18","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 18 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM3","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 3 EVERY 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DM6","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 6 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DMEP","ALLOWABLE BENEFIT UP TO PURCHASE PRICE HAS BEEN MET, NO ADDITIONAL BENEFIT IS PAYABLE FOR RENTAL","M7","No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DMX","CLAIM PROCESSED PER PARTICIPATING CONTRACT OR FEE SCHEDULE.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["DNMC","PROCESSED IN ACCORDANCE WITH OUT OF NETWORK REIMBURSEMENT RULES.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["DNVD","CLAIM HAS BEEN MISDIRECTED.  THIS IS NOT A COVERED SERVICE UNDER THE PLAN. PLEASE SUBMIT CLAIM TO DENTAQUEST OF ILLINOIS,LLC FOR CONSIDERATION","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["DR","APPEAL DENIED, ADEQUATE DOCUMENTATION TO SUBSTANTIATE REQUEST NOT SUBMITTED.","","","CO","Contractual Obligations","285","Appeal procedures not followed"]
["DRA","\"Readmission Denial Upheld\"","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["DRGO","DRG INDICATOR SUBMITTED ON OUTPATIENT SERVICE CLAIM. PLEASE RESUBMIT CORRECTLY.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DRV","ITEM SHOULD BE PURCHASED THROUGH PHARMACY VENDOR","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["DS","THE NUMBER OF DAYS BILLED DOES NOT MATCH THE DATE SPAN ON THE CLAIM.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EABD","ELECTIVE ABORTION REQUIRES PREAUTHORIZATION AND THE APPROPRIATE HFS ABORTION PAYMENT APPLICATION FORM.","N398","Missing elective consent form.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["EAIP","EAPG DENIAL. INVALID PROCEDURE, CANNOT BE BLANK","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EAMM","DOCUMENTATION WAS NOT PROVIDED TO SUPPORT THE ELIGIBILITY OF THIS SERVICE.","N706","Missing documentation.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["EANC","EAPG DENIAL. NON-COVERED REVENUE CODE PRESENT.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FQUB","T1015/S5190 IS ONLY ABLE TO BE SUBMITTED ON HCFA-1500 FORMS PER HFS.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FRD","PROVIDER UNDER INVESTIGATION. FOR MORE INFORMATION CALL PROVIDER RELATIONS.","","","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["FTHF","Payment Integrity credit balance recovery/recoupment that was by the Trend Health team and is a full take back on the paid claim amount.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["FTHP","Payment Integrity credit balance recovery/recoupment that was by the Trend Health team and is a partial take back on the paid claim amount.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["GEMT","Ground emergency transportation claims need to be submitted to HFS directly.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["GFR","PRE-OPERATIVE OR PRE-ADMISSION TESTING IS INCLUDED WITH THE GLOBAL FACILITY REIMBURSEMENT.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["GIS","THE SERVICES ARE INCLUDED IN THE GLOBAL IMAGING SERVICE AND ARE NOT SEPARATELY REIMBURSABLE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["GAP","THE SERVICE DATE(S) BILLED FALL DURING A TIME WHEN THE MEMBER HAD A GAP IN COVERAGE.","N650","This policy was not in effect for this date of loss. No coverage is available.","CO","Contractual Obligations","200","Expenses incurred during lapse in coverage"]
["H47","PROCEDURE CODE COMBINATION NOT ALLOWED.","N20","Service not payable with other service rendered on the same date.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["HAR1","ONE PAIR OF EYEGLASSES A YEAR","N640","Exceeds number/frequency approved/allowed within time period.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["HAR5","ONE PAIR OF EYEGLASSES EVERY 5 YEARS","N640","Exceeds number/frequency approved/allowed within time period.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["HAX","MEMBER EXCEEDS AGE LIMIT FOR HEARING BENEFIT","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["HCFA","FACILITY NOT ALLOWED TO BILL ON A HCFA.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["HCRA","THIS ADDITIONAL PAYMENT REFLECTS 37.9% NY SURCHARGE ON PATIENT LIABILITY.","","","CO","Contractual Obligations","225","Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)"]
["HEAR","MAXIMUM FREQUENCY EXCEEDED. HEARING AIDS/COCHLEAR IMPLANTS ONE EVERY 12 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["HH90","HOME HEALTH SERVICES ARE LIMITED TO 90 VISITS WITHIN A TWELVE MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["HHFA","SERVICES SHOULD BE BILLED ON HCFA.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["HHS","HOME HEALTH SERVICES LIMITED TO 100 VISITS PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["HHV","HOME HEALTH VISITS: 1 visit per day, if the CPT code is not listed in the contract it is not paid.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["HMSC","HMS WILL RECOUP DUE TO COB","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["HPCF","HFS - member was not found on Patient Credit File (PCF), therefore services are denied.","MA43","Missing/incomplete/invalid patient status.","CO","Contractual Obligations","177","Patient has not met the required eligibility requirements."]
["IM0","THE CODE BILLED IS NOT ALLOWED PER INDIANA MEDICAID GUIDELINES.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["75","DIRECT MEDICAL EDUCATION ADJUSTMENT.","N14","","CO","Contractual Obligations","75","Direct Medical Education Adjustment."]
["76","DISPROPORTIONATE SHARE ADJUSTMENT.","N14","","CO","Contractual Obligations","76","Disproportionate Share Adjustment."]
["78","NON-COVERED DAYS/ROOM CHARGE ADJUSTMENT.","N14","","CO","Contractual Obligations","78","Non-Covered days/Room charge adjustment."]
["89","PROFESSIONAL FEES REMOVED FROM CHARGES.","","","CO","Contractual Obligations","89","Professional fees removed from charges."]
["C250","$250 PATIENT COPAY AMOUNT","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C300","$300 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C350","$350 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C375","$375 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C600","$600 PATIENT COPAY AMOUNT.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["C978","CLAIM HAS BEEN REPROCESSED TO REFLECT UPDATED PATIENT CREDIT FILE INFORMATION.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","3","Co-payment Amount"]
["CAMB","Claim text note not within state transportation guidelines Eff: 1/1/17","","","OA","OA Other adjustments","272","Coverage/program guidelines were not met."]
["CB","PRIMARY INSURANCE PAYMENT IS BEING DEDUCTED FROM THE NET PAYMENT, IF APPLICABLE.","","","OA","OA Other adjustments","23","The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)"]
["CBST","PAYMENT MADE IN ACCORDANCE WITH STATE TITLE IV-D REQUIREMENTS.","N14","","CO","Contractual Obligations","100","Payment made to patient/insured/responsible party."]
["CC01","PLEASE SUBMIT THE LETTER OF CREDIBLE COVERAGE AND OR WRITTEN DOCUMENTATION FROM THE PRIMARY INSURANCE PLAN TO CONFIRM TERMINATION DATE OF COVERAGE","MA92","Missing plan information for other insurance.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["94","PROCESSED IN EXCESS OF CHARGES.","N14","","CO","Contractual Obligations","94","Processed in Excess of charges."]
["IFQH","INVALID POS CODE SUBMITTED FOR FQHC","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["HPPE","SERVICE NOT PAYABLE WHEN BILLED ON THE SAME CLAIM AS HOSPICE PRE-ELECTION EVAULATION AND COUNSELING.","N20","Service not payable with other service rendered on the same date.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IA51","THE T1015 ENCOUNTER CODE MUST BE BILLED FIRST IN SEQUENCE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IIPP","Invalid inpatient principal procedure.","MA66","Missing/incomplete/invalid principal procedure code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["90C","DENIED DUE TO NON-TIMELY FILING OF A CORRECTED CLAIM - PLEASE REFERENCE COUNTYCARE BILLING MANUAL\"","","","CO","Contractual Obligations","29","The time limit for filing has expired."]
["ABNC","DOCUMENTATION WAS NOT PROVIDED TO SUPPORT THE NECESSITY OF THESE SERVICES.","N661","Documentation does not support that the services rendered were medically necessary.","OA","OA Other adjustments","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ABOR","ABORTION CODES ARE NOT REIMBURSABLE THROUGH THE HEALTH PLAN. PLEASE BILL HFS DIRECTLY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["ABS","THIS SERVICE HAS BEEN SPLIT OUT FROM THIS CLAIM AND IS BEING PROCESSED UNDER A SEPARATE CLAIM NUMBER.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["AC","APPEAL DENIED. REFER TO PROVIDER ON ATTACHED AUTH IS NOT THE BILLING PROVIDER","MA130","Your 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.","CO","Contractual Obligations","296","Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the provider."]
["AIR","ADDITIONAL INFORMATION RECEIVED DOES NOT WARRANT ADDITIONAL BENEFITS.","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["9","THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT''S AGE.","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ACCU","CLAIM HAS BEEN RE-CALCULATED DUE TO CORRECTION OF DEDUCTIBLE/COINSURANCE. PLEASE REIMBURSE MEMBER ANY AMOUNT IN EXCESS OF THE PATIENTS RESPONSIBILITY.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["ADJ","ADJUSTED DUE TO RECEIPT OF CORRECT CLAIM.","","","CO","Contractual Obligations","169","Alternate benefit has been provided."]
["ADM","ADMINISTRATION CODES ARE NOT REIMBURSABLE THROUGH THE HEALTH PLAN.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["ANNI","Attending Provider NPI Not for Individuals","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["ANPE","Attending Provider NPI Not Enrolled","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["AP","APPEAL REVIEWED, NO FURTHER BENEFIT PAYABLE","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["AP2","SECOND LEVEL CLAIM APPEAL REVIEWED - DENIAL IS UPHELD","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["APD","APPEAL DENIED - NO AUTHORIZATION RECEIVED.","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["APPA","APPEAL HAS BEEN RECEIVED AND REVIEWED. ADDITIONAL PAYMENT IS WARRANTED.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["APR","APPEAL RECEIVED - CLAIM REPROCESSED.","","","CO","Contractual Obligations","169","Alternate benefit has been provided."]
["APRE","ADJUSTMENT MADE TO ALLOWED AMOUNT TO DEDUCT PAYMENT MADE ON PRIOR CLAIM FOR OTHER E/M CODE WHICH IS INCLUDED IN BENEFIT ON CURRENT CLAIM.","N432","Alert: Adjustment based on a Recovery Audit.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["AR","APPEAL DENIED. AUTHORIZATION REQUESTED FROM DCHP AFTER SERVICES RENDERED.","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["AS","APPEAL DENIED, SERVICES NOT ELIGIBLE FOR REIMBURSEMENT.","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["ADRG","APR-DRG WAS USED TO PRICE CLAIM.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["ASNC","ASSISTANT SURGEON SERVICES NOT COVERED FOR THIS PROVIDER TYPE.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["AX","SERVICE RENDERED PRIOR TO/AFTER AUTHORIZATION EFFECTIVE AND EXPIRATION DATES.","N351","Service date outside of the approved treatment plan service dates.","CO","Contractual Obligations","198","Precertification/notification/authorization/pre-treatment exceeded."]
["B1","NON-COVERED VISITS.","","","CO","Contractual Obligations","B1","Non-covered visits."]
["B10","ALLOWED AMOUNT HAS BEEN REDUCED BECAUSE A COMPONENT OF THE BASIC PROCEDURE/TEST WAS PAID. THE BENEFICIARY IS NOT LIABLE FOR MORE THAN THE CHARGE LIMIT FOR THE BASIC PROCEDURE/TEST.","N14","","CO","Contractual Obligations","B10","Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test."]
["B11","THE CLAIM/SERVICE HAS BEEN TRANSFERRED TO THE PROPER PAYER/PROCESSOR FOR PROCESSING. CLAIM/SERVICE NOT COVERED BY THIS PAYER/PROCESSOR.","N418","Misrouted claim.  See the payer's claim submission instructions.","CO","Contractual Obligations","B11","The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor."]
["B12","SERVICES NOT DOCUMENTED IN PATIENTS' MEDICAL RECORDS.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","B12","Services not documented in patient's medical records."]
["B13","PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT.","N111","No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.","CO","Contractual Obligations","B13","Previously paid. Payment for this claim/service may have been provided in a previous payment."]
["B14","ONLY ONE VISIT OR CONSULTATION PER PHYSICIAN PER DAY IS COVERED.","","","CO","Contractual Obligations","B14","Only one visit or consultation per physician per day is covered."]
["B15","THIS SERVICE/PROCEDURE REQUIRES THAT A QUALIFYING SERVICE/PROCEDURE BE RECEIVED AND COVERED. THE QUALIFYING OTHER SERVICE/PROCEDURE HAS NOT BEEN RECEIVED/ADJUDICATED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","B15","This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["B16","NEW PATIENT' QUALIFICATIONS WERE NOT MET.","N30","Patient ineligible for this service.","CO","Contractual Obligations","B16","New Patient' qualifications were not met."]
["B20","PROCEDURE/SERVICE WAS PARTIALLY OR FULLY FURNISHED BY ANOTHER PROVIDER.","N472","Payment for this service has been issued to another provider.","CO","Contractual Obligations","B20","Procedure/service was partially or fully furnished by another provider."]
["B22","THIS PAYMENT IS ADJUSTED BASED ON THE DIAGNOSIS.","N432","Alert: Adjustment based on a Recovery Audit.","CO","Contractual Obligations","B22","This payment is adjusted based on the diagnosis."]
["B23","PROCEDURE BILLED IS NOT AUTHORIZED PER YOUR CLINICAL LABORATORY IMPROVEMENT AMENDMENT (CLIA) PROFICIENCY TEST.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","B23","Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test."]
["B4","LATE FILING PENALTY.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","B4","Late filing penalty."]
["B5","COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["B7","THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["B8","ALTERNATIVE SERVICES WERE AVAILABLE, AND SHOULD HAVE BEEN UTILIZED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","B8","Alternative services were available, and should have been utilized. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["B9","PATIENT IS ENROLLED IN A HOSPICE.","","","CO","Contractual Obligations","B9","Patient is enrolled in a Hospice."]
["BH3","SERVICES LIMITED TO 3 UNITS PER DAY","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["BHCP","NON-CONTRACTED CODE.  PLEASE CONTACT BHCP AT 1-855-481-7047 FOR QUESTIONS REGARDING YOUR CONTRACT AND/OR FEE SCHEDULE.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["BHF","MAXIMUM FREQUENCY ONE UNIT PER MEMBER PER DAY","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["BIER","CLAIM BILLED IN ERROR PER NOTIFICATION FROM PROVIDER, PLEASE DISREGARD.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["BIL","BILLED CHARGES ARE INELIGIBLE AS A CORRECTED CLAIM/INFORMATION HAS BEEN RECEIVED.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["BLOD","THE PLAN DOES NOT PROVIDE BENEFITS FOR ANY BLOOD, BLOOD DONORS, OR PACKED RED BLOOD CELLS WHEN PARTICIPATION IN A VOLUNTARY BLOOD PROGRAM  IS AVAILABLE.","","","CO","Contractual Obligations","66","Blood Deductible."]
["CCCG","Corrected claim payment processed according to revised coding.","MA67","Alert: Correction to a prior claim.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["CCCH","THIS CLAIM HAS BEEN PUT ON HOLD AT THE REQUEST OF COUNTYCARE COMPLIANCE","","","CO","Contractual Obligations","104","Managed care withholding."]
["CCEN","Cook County clinics are no longer enrolled as encounter clinics as of 4/1/2020.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["CCLM","CORRECTED CLAIM RECEIVED, NO ADDITIONAL BENEFITS ALLOWED","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["CCNO","Corrected Claim Received without coding modification. Please rebill claim with updated coding based on medical record audit findings letter received.","MA67","Alert: Correction to a prior claim.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["CCOP","CORRECTED CLAIM RECEIVED.  CHARGES PREVIOUSLY CONSIDERED ON PRIOR CLAIM RESULTING IN AN OVERPAYMENT.  LETTER TO FOLLOW.","MA67","Alert: Correction to a prior claim.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["CCR","CORRECTED CLAIM RECEIVED","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["CDRG","Claim processed to pay with correct DRG per medical record review.","","","CO","Contractual Obligations","A8","Ungroupable DRG."]
["D100","DIAGNOSIS CODE BILLED IS NOT VALID","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D15","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 15 PER 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["CCS","CUSTODIAL CARE SERVICES ARE NOT COVERED UNDER THE PLAN.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D19","CLAIM/SERVICE LACKS PHYSICIAN/OPERATIVE OR OTHER SUPPORTING DOCUMENTATION.","M29","Missing operative note/report.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["D1P3","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 3 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D20","CLAIM/SERVICE MISSING SERVICE/PRODUCT INFORMATION.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["D22","INVALID AGE FOR THIS BENEFIT.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["D23M","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DEAP","UNABLE TO PRICE WITH EAPG CALCULATION AT THIS TIME. PLEASE SEE OTHER DENIAL/REJECTION CODE(S).","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["DENA","SERVICES DENIED AT THE TIME AUTHORIZATION/PRECERTIFICATIONS WAS REQUESTED","","","CO","Contractual Obligations","39","Services denied at the time authorization/pre-certification was requested."]
["DENT","SUBMIT CLAIM TO CORRECT PAYER. PLAN DOES NOT COVER DENTAL","N216","We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["DETA","99000 MUST BE BILLED SEPARATELY FROM ENCOUNTER CODE","N61","Rebill services on separate claims.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DFBC","A $35.00 DISPENSING FEE IS ALLOWED WHEN BILLED WITH THE \"UD\" MODIFIER FOR HIGHLY EFFECTIVE BIRTH CONTROL METHODS PURCHASED THROUGH THE 340B FEDERAL DRUG PROGRAM.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["DFBD","A $35.00 DISPENSING FEE IS ALLOWED FOR 340B ENROLLED PROVIDERS WHEN BILLED WITH THE APPROPRIATE MODIFIER.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EANO","NO PAYMENT PER EAPG REIMBURSEMENT","","","CO","Contractual Obligations","256","Service not payable per managed care contract."]
["EAPA","EAPG PRICING. PACKAGING APPLIES.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["EAPG","EAPG PRICING APPLIES","","","CO","Contractual Obligations","P6","Based on entitlement to benefits. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only."]
["EAPN","REQUIREMENT FOR IL EAPG PROCESSING NOT MET.","","","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["EARA","EAPG PRICING. REPEAT ANCILLARY DISCOUNTING APPLIES.","","","CO","Contractual Obligations","B10","Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test."]
["EARC","EAPG DENIAL. REVENUE CODE REQUIRES HCPCS CODE ON SAME LINE.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EC","GLOBAL FEE; INCLUDED IN ENCOUNTER RATE","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ECD","Requested itemized bill was not received within the 30-day time limit for review. Claim has been denied. For additional information, please contact Equian at 800-304-5649.","N26","Missing itemized bill/statement.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["ECF","Requested medical records were not received within the 30-day time limit for review. Claim has been denied. For additional information,  please contact Optum at 949-336-4862.","N706","Missing documentation.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["DAT","ADMIN DATE GREATER THAN DISCHARGE DATE","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DB","MEMBER''S DATE OF BIRTH ON FILE DOES NOT MATCH DATE OF BIRTH ON HCFA/UB. PLEASE VERIFY","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["D77","MULTIPLE DATES OF SERVICE ON ERC CLAIM","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EDER","ED Code level inconsistent with related claim.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["EHDR","Claim has been flagged for High Dollar Review by Optum. Please fax the full Itemized Bill and Medical Record Documentation to 714-673-6956. For additional information, please contact Optum at 949-336-4862.","N706","Missing documentation.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["IMDC","MANIFESTION CODES ARE NOT ALLOWED AS THE ADMISSION DIAGNOSIS.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INDR","INFORMATIONAL CODE ONLY.  PATIENT IS NOT RESPONSIBLE FOR SERVICE","","","CO","Contractual Obligations","B1","Non-covered visits."]
["INFA","ASC billing needs to be billed by facility not individual provider","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INFD","CLAIM MUST BE BILLED WITH INFUSION DRUG OR APPROPRIATE REV CODE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INFX","THE PLAN DOES NOT PROVIDE BENEFITS RELATED TO INFERTILITY.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["INJ","INJECTIONS MUST BE BILLED WITH INJECTED DRUG CODE","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["J146","RECOUPMENT REQUIRED. CLAIMS PAID BY PRIMARY INSURANCE, MEDICARE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["J18","RECOUPMENT MADE DUE TO CLAIM PAID IN ERROR","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["J226","RECOUPMENT MADE FOR INTEREST PAID IN ERROR","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JBIL","RECOUPMENT HAS BEEN MADE DUE TO BILLING ERROR.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["JC18","RECOUPMENT DUE TO DUPLICATE CLAIM/SERVICE.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["JCCC","RECOUPMENT MADE DUE TO RECEIPT OF CORRECTED CLAIM AND/OR ADDITIONAL INFORMATION FROM PROVIDER.","MA67","Alert: Correction to a prior claim.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["JCFS","RECOUPMENT HAS BEEN MADE DUE TO AN UPDATE TO THE PROVIDER'S FEE SCHEDULE WHICH NOW RESULTED IN AN OVERPAYMENT","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JCIB","RECOUPMENT MADE DUE TO AN INCORRECT BENEFIT PREVIOUSLY PAID.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["JCIP","RECOUPMENT MADE DUE TO INCORRECT PAYOR.","N280","Missing/incomplete/invalid pay-to provider primary identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JCME","RECOUPMENT DUE TO MEMBER NOT ELIGIBLE ON DATES OF SERVICE.","","","OA","OA Other adjustments","27","Expenses incurred after coverage terminated."]
["JCPE","RECOUPMENT MADE DUE TO CLAIM PAID IN ERROR","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PWCF","Payment Integrity waste and error audit recovery/recoupment that was identified by the Claris team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PWCP","Payment Integrity waste and error audit recovery/recoupment that was identified by the Claris team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PWIF","Payment Integrity waste and error audit recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PWIP","Payment Integrity waste and error audit recovery/recoupment that was internally identified by the Evolent team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PWR","THE SUBMITTED EOP FROM THE PRIMARY INSURANCE DOES NOT MATCH THE SERVICE/DATE(S) RENDERED.","N4","Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["INT","INTEREST PAYMENT APPLIED TO CLAIM. INITIAL PAYMENT EXCEEDED 30 DAYS.","","","CO","Contractual Obligations","225","Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)"]
["INV","PLEASE SUBMIT THE M.S.R.P. OR MANUFACTUROR''S INVOICE FOR THESE SERVICES.","M23","Missing invoice.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["LEOB","EOB RECEIVED IS NOT LEGIBLE.","MA04","Secondary payment cannot be considered without the identity of or payment information from the primary payer.  The information was either not reported or was illegible.","CO","Contractual Obligations","251","The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["LTC1","PATIENT LIABILITY WAS APPLIED.","","","OA","OA Other adjustments","3","Co-payment Amount"]
["LTCI","LTC CLAIMS MUST BE BILLED ON A UB-04/837I FORMAT.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INR","INTERVENTIONAL SURGERY PROCEDURE CODE MUST BE BILLED","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["M3K","MAXIMUM BENEFIT OF $3000.00 PER CALENDAR YEAR HAS BEEN EXHAUSTED.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["MAMB","Modifer not within state transportation guidelines Eff: 1/1/17","N519","Invalid combination of HCPCS modifiers.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MARP","Missing or Invalid Attending/Referring Provider NPI","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["MCMB","Modifier & claim text note not within state transportation guidelines Eff: 1/1/17","","","OA","OA Other adjustments","272","Coverage/program guidelines were not met."]
["MCSP","THE ROOM CHARGE EXCEEDS THE MOST COMMON SEMI-PRIVATE RATE FOR THIS HOSPITAL.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["MDR","CLAIM HAS BEEN MISDIRECTED.  PLEASE SUBMIT CLAIM TO MIRADOR - C/O QHM ATTN:  BARBARA SANCHEZ 15280 NW 79TH CT, SUITE 100,  MIAMI LAKES, FL 33016.","N418","Misrouted claim.  See the payer's claim submission instructions.","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["MDRD","MCHO HAS REVIEWED THE MEDICAL DOCUMENTATION PROVIDED UPON OUR REQUEST.  THE MEDICAL DOCUMENTATION DID NOT SUPPORT THE BILLING OF THIS SERVICE.  AS A RESULT, THE PAYMENT IS BEING RETROACTIVELY DENIED.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["ME","MEMBER NOT ELIGIBLE ON DATES OF SERVICES.","","","PR","PR Patient Responsibility","200","Expenses incurred during lapse in coverage"]
["MEEC","MEMBER NOT ELIGIBLE FOR EXCEPTIONAL CARE - CLAIM DENIED.","N30","Patient ineligible for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["MEM","MEMBER ID SUBMITTED IS NOT CURRENT. PLEASE RESUBMIT WITH CORRECT MEMBER ID.","N382","Missing/incomplete/invalid patient identifier.","CO","Contractual Obligations","140","Patient/Insured health identification number and name do not match."]
["MNF","SERVICES WILL BE RECONSIDERED WHEN THE INFORMATION REQUESTED FROM THE MEMBER IS RECEIVED.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MO95","To deny claims of modifier 95. Modifier 95 is not billable per HFS modifier list.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["MODF","SERVICES ONLY PAYABLE WITH APPROPRIATE MODIFIER(S).","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MUE","UNITS EXCEED MEDICARE'S UNLIKELY EDITS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["MX","PROCESSED PER PARTICIPATING CONTRACT OR FEE SCHEDULE.  SERVICES WITH NO ASSIGNED FEE OR WHICH ARE CONSIDERED INCLUSIVE/PACKAGED WILL RESULT IN $0.00 PAYMENT.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["N34","INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["N615","ALERT: THIS ENROLLEE RECEIVING ADVANCE PAYMENTS OF THE PREMIUM TAX CREDIT IS IN THE GRACE PERIOD OF THREE CONSECUTIVE MONTHS FOR NON-PAYMENT OF PREMIUM.  UNDER THE CODE OF FEDERAL REGULATIONS, TITLE 45, PART 156.270, A QUALIFIED HEALTH PLAN ISSUER MUST PAY ALL APPROPRIATE CLAIMS FOR SERVICES RENDERED TO THE ENROLLEE DURING THE FIRST MONTH OF THE GRACE PERIOD AND MAY PEND CLAIMS FOR SERVICES RENDERED TO THE ENROLLEE IN THE SECOND AND THIRD MONTHS OF THE GRACE PERIOD.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["N616","ALERT: THIS ENROLLEE IS IN THE FIRST MONTH OF THE ADVANCE PREMIUM TAX CREDIT GRACE PERIOD.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["N617","THIS ENROLLEE IS IN THE SECOND OR THIRD MONTH OF THE ADVANCE PREMIUM TAX CREDIT GRACE PERIOD.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["N618","ALERT: THIS CLAIM WILL AUTOMATICALLY BE REPROCESSED IF THE ENROLLEE PAYS THEIR PREMIUMS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["N619","COVERAGE TERMINATED FOR NON-PAYMENT OF PREMIUM.","N619","Coverage terminated for non-payment of premium.","OA","OA Other adjustments","177","Patient has not met the required eligibility requirements."]
["OBEA","OBSERVATION UNITS NOT BEING BILLED CORRECTLY PER HFS GUIDELINES.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["OBNC","OBSERVATION CLAIM NOT BILLED PER HFS BILLING GUIDELINES EFFECTIVE 01/01/2017.","N182","This claim/service must be billed according to the schedule for this plan.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["OBP","OON PURCHASE OF SUPPLY AFTER 03/01/2014 WILL GO TOWARDS YOUR OUT OF NETWORK DEDUCTIBLE/OUT OF POCKET.","","","OA","OA Other adjustments","1","Deductible Amount"]
["MORP","Missing or Invalid Referring/Ordering Provider NPI","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["MOU2","U2 MODIFIER IS ONLY ALLOWED FOR HOME HEALTH SERVICES","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MR","PLEASE SUBMIT MEDICAL RECORDS FOR CLAIM CONSIDERATION.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MRF","MEMBER/PROVIDER REIMBURSEMENT FORM NOT COMPLETE","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MS","PAYMENT REDUCED FOR MULTIPLE PROCEDURES.","N670","This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["OB72","OBSERVATION SERVICES CANNOT EXCEED 72HRS.  ANY SERVICES ORDERED AFTER 72 HOURS OF OBSERVATION MUST NOT BE INCLUDED ON THE OUTPATIENT OBSERVATION CLAIM NOR BILLED TO THE CLIENT.  PLEASE SUBMIT A CORRECTED CLAIM.","N640","Exceeds number/frequency approved/allowed within time period.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["OCU","MUST BILL OCCULAR PROSTHESIS WITH IMPLANT PROCEDURE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["OT10","BILLABLE BY FQHC/RHC/ENCOUNTER RATE CLINIC ONLY.  NOT BILLING WITH APPROPRIATE ADDRESS/NPI.","","","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["OTNC","Offset for STNC","N428","Not covered when performed in this place of service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["P01","PROVIDER NOT ELIGIBLE FOR CATEGORY OF SERVICE.","N238","Incomplete/invalid physician certified plan of care.","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["OBSD","PAYMENT WILL NOT BE ALLOWED FOR OBSERVATION CARE FOR CONSECUTIVE DATES OF SERVICE. ALSO, ONLY ONE OBSERVATION CPT CODE MAY BE BILLED.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PAIF","Payment Integrity hospital bill audit recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PAIP","Payment Integrity hospital bill audit recovery/recoupment that was internally identified by the Evolent team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PRER","REIMBURSEMENT HAS BEEN REDUCED DUE TO PREADMISSION/PREOPERATIVE TESTING PAID WITHIN 72 HOURS.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["PROS","PENILE PROSTHESIS MUST BE BILLED WITH PROCEDURE CODES FOR INSERTION","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PSYC","CODE CANNOT BE BILLED AS A STAND ALONE CODE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PSYH","CLAIM HAS BEEN MISDIRECTED.  THIS IS NOT A COVERED SERVICE UNDER THE PLAN. PLEASE SUBMIT CLAIM TO BEHAVIORAL HEALTH VENDOR FOR CONSIDERATION.","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["PVT","PRIVATE ROOM CHARGES ARE NOT COVERED","","","CO","Contractual Obligations","78","Non-Covered days/Room charge adjustment."]
["FCOB","Payment Integrity coordination of benefits recovery/recoupment that was internally identified by the Evolent team and is a partial take back on the paid claim amount.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["FHFS","FAILURE TO ADHERE TO HFS GUIDELINES.","N646","Reimbursement has been adjusted based on the guidelines for an assistant.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["FHN","CLAIM HAS BEEN PAID IN ACCORDANCE WITH FIRST HEALTH NETWORK CONTRACT","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["FHUB","FAILURE TO ADHERE TO HFS GUIDELINES-D01/UB DUPLICATE.","","","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["FLVA","SERVICES ARE LIMITED TO FOUR PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["FMR1","Payment Integrity DRG Audit recovery/recoupment that was identified by the MedReview team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FMR2","Payment Integrity DRG Audit recovery/recoupment that was identified by the MedReview team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FMR3","Payment Integrity hospital bill audit recovery/recoupment that was identified by the MedReview team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FMR4","Payment Integrity hospital bill audit recovery/recoupment that was identified by the MedReview team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FEO","Payment Integrity coordination of benefits recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim amount.","N479","Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FQBG","MUST INCLUDE DETAIL LINES PER HFS BILLING GUIDELINES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["FQHC","PAID AT FQHC RATE","","","CO","Contractual Obligations","131","Claim specific negotiated discount."]
["FQPO","FQHC SERVICES MUST BE BILLED WITH THE APPROPRIATE PLACE OF SERVICE CODE.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IB","PLEASE SUBMIT ITEMIZED BILL","N26","Missing itemized bill/statement.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["IPRB","INPT REHAB LIMITED TO 90 DAYS PER CALENDER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["JFPL","REFUND RECEIVED DUE TO PRIMARY INSURANCE PAYMENT LESS THAN PAYABLE BENEFIT.  ADDITIONAL PAYMENT IS WARRANTED.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JFPP","SUBROGATION REFUND RECEIVED. CLAIM PAID BY MOTOR VEHICLE INSURANCE, WORKERS COMPENSATION OR OTHER INSURANCE","N573","Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JFRP","A REFUND CHECK HAS BEEN RECEIVED FOR BENEFITS THAT HAVE BEEN RECOUPED FOR THIS PROVIDER.  REFUND PAYMENT IS BEING REISSUED.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JIBR","INTERIM BILL RECEIVED.  CLAIMS WILL BE REVIEWED UPON RECEIPT OF THE FINAL BILL WITH ITEMIZED STATEMENT.","","","CO","Contractual Obligations","135","Interim bills cannot be processed."]
["JIHS","RECOUPMENT DUE TO THIS PROCEDURE WHICH IS NOT PAYABLE IN AN INPATIENT AND OUTPATIENT SETTING.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JIMI","RECOUPMENT DUE TO THE ORIGINAL CLAIM BEING PROCESSED UNDER THE INCORRECT MEMBER OR INCORRECT MEMBER ID NUMBER.","N382","Missing/incomplete/invalid patient identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JIPE","RETURNING INTEREST TAKEN IN ERROR.","","","OA","OA Other adjustments","85","Patient Interest Adjustment (Use Only Group code PR)"]
["JMID","REFUND DUE TO THE ORIGINAL CLAIM BEING PROCESSED UNDER THE INCORRECT MEMBER OR INCORRECT MEMBER ID NUMBER.","","","CO","Contractual Obligations","140","Patient/Insured health identification number and name do not match."]
["JMNE","REFUND RECEIVED DUE TO MEMBER NOT ELIGIBLE ON DATES OF SERVICE.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["JOPO","RECOUPMENT DUE TO AN OVERPAYMENT ON THIS CLAIM THE NEGATIVE AMOUNT IS AN OFFSET OF PAYMENT","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JP01","Payment Integrity program review - Billing for services not rendered","N35","Program integrity/utilization review decision.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JP02","Payment Integrity program review - Billing for services that are not medically necessary","N661","Documentation does not support that the services rendered were medically necessary.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JP03","Payment Integrity program review - Upcoding","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JP04","Payment Integrity program review - Unbundling","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JP05","Payment Integrity program review - Failure to Respond to Audit Request","M127","Missing patient medical record for this service.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JP06","Payment Integrity program review - Insufficient Documentation","N705","Incomplete/invalid documentation.","CO","Contractual Obligations","251","The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["JP07","Payment Integrity program review - Illegible documentation","N35","Program integrity/utilization review decision.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JP08","Payment Integrity program review - Undercoding","N35","Program integrity/utilization review decision.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JP09","Payment Integrity program review - Records received after due date","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","164","Attachment/other documentation referenced on the claim was not received in a timely fashion."]
["JP10","Payment Integrity program review - Hospital Transfer Billed as Discharge","n35","Program integrity/utilization review decision.","oa","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JP11","Special Investigation Unit â\u0080\u0093 Claim included in extrapolated overpayment","N581","Investigation of coverage eligibility is pending.","CO","Contractual Obligations","55","Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JPPI","RECOUPMENT DUE TO PREVIOUSLY PAID INTEREST","","","CO","Contractual Obligations","225","Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)"]
["JRCT","REFUND IS DUE TO EXPENSES INCURRED AFTER COVERAGE WAS TERMINATED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JREC","PAYMENT FOR SERVICE WAS NOT PROCESSED IN ACCORDANCE WITH THE PLAN RULES, RESULTING IN AN OVERPAYMENT.  MCHO IS REQUESTING A REFUND OF THE TOTAL AMOUNT PAID ON THE CLAIM LINE. THE CHECK SHOULD BE MADE PAYABLE TO MCHO, THE APPLICABLE CLAIM NUMBER(S) NOTED AND MAILED TO MCHO AT:  MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200 PO BOX 1121, LEWISTON, ME 04243.  IF A REFUND CHECK IS NOT RECEIVED WITHIN 30 DAYS, THE AMOUNT OF THE OVERPAYMENT WILL BE RECOUPED FROM FUTURE PAYMENTS YOU MAY RECEIVE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JREF","REFUND RECEIVED","N245","Incomplete/invalid plan information for other insurance.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JRFC","REFUND RETURNED COB REQUEST CANCELLED.","","","OA","OA Other adjustments","22","This care may be covered by another payer per coordination of benefits."]
["JRR","A REFUND WAS RECEIVED AND IS BEING RETURNED AS THE CLAIM WAS PROCESSED CORRECTLY.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JTPP","Refund Received. Claim paid by Motor Vehicle Insurance/other Insurance","N744","Adjusted because the services may be related to an auto/other accident.","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["JWM","Rev 0636 not covered with JW Modifier","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["J135","BILLED UNDER INCORRECT TAX IDENTIFICATION NUMBER.","N209","Missing/incomplete/invalid taxpayer identification number (TIN).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JCPL","RECOUPEMENT MADE DUE TO PRIMARY INSURANCE PAYMENT LESS THAN THE PAYABLE BENEFIT.  ADDITIONAL PAYMENT IS WARRANTED.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JCR","REFUND DUE TO CODE BEING A COMPOUND PROCEDURE, PAYMENT INCLUDED WITH COMPREHENSIVE PROCEDURE CODE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JEO","RECOUP IS BEING DONE ON THIS CLAIM DUE TO OTHER INSURANCE NOTIFICATION.  PLEASE RESUBMIT THE PRIMARY EXPLANATION OF BENEFITS FOR RECONSIDERATION OF THIS CLAIM.","MA04","Secondary payment cannot be considered without the identity of or payment information from the primary payer.  The information was either not reported or was illegible.","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["JF18","DUPLICATE PAYMENT.","M86","Service denied because payment already made for same/similar procedure within set time frame.","OA","OA Other adjustments","B13","Previously paid. Payment for this claim/service may have been provided in a previous payment."]
["JF46","REFUND RECEIVED . CLAIMS PAID BY PRIMARY INSURANCE","","","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["JFBE","REFUND RECEIVED DUE TO INCORRECT SUBMISSION/BILLING ERROR.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["JFCE","REFUND RECEIVED DUE TO CLAIM PAID IN ERROR","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["JFDR","A REFUND WAS RECEIVED PREVIOUSLY FOR THIS CLAIM AND WAS POSTED.   DUPLICATE REFUND IS NOW BEING RE-ISSUED.","MA131","Physician 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.","CO","Contractual Obligations","195","Refund issued to an erroneous priority payer for this claim/service."]
["JFFS","REFUND HAS BEEN MADE DUE TO AN UPDATE TO THE PROVIDER'S FEE SCHEDULE WHICH NOW RESULTED IN AN OVERPAYMENT","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["JFIB","REFUND RECEIVED DUE TO AN INCORRECT BENEFIT PREVIOUSLY PAID.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["JFIP","REFUND RECEIVED DUE TO CLAIM PAID TO THE INCORRECT PROVIDER.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["JFNP","PAYER REFUND AMOUNT - NOT OUR PATIENT.","","","CO","Contractual Obligations","31","Patient cannot be identified as our insured."]
["JFPC","A REFUND WAS RECEIVED FOR THIS CLAIM THAT WAS PREVIOUSLY PAID CORRECTLY.  BENEFITS ARE NOW BEING REISSUED.","","","OA","OA Other adjustments","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["IUPD","DIAGNOSIS IS UNACCEPTABLE AS PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["L150","SERVICE EXCEEDS QUANTITY LIMITATIONS. T4541 ARE LIMITED TO 150 EVERY 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["L200","SERVICE EXCEEDS QUANTITY LIMITATIONS.  INCONTINENCE SUPPLIES ARE LIMITED TO 200 EVERY 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NUC","MUST BILL RADIOPHARMECEUTICAL PROCEDURE WITH NUCLEAR MEDICINE PROCEDURE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NUNA","SERVICES DENIED.  NUTRITIONAL COUNSELING NOT AUTHORIZED.","","","CO","Contractual Obligations","167","This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["LCHG","SERVICES PAID ACCORDING TO PROVIDER CONTRACT. NO ADDITIONAL PAYMENT DUE.","","","CO","Contractual Obligations","20","This injury/illness is covered by the liability carrier."]
["NAB","ADDITIONAL INFORMATION RECEIVED AND REVIEWED.  NO ADDITIONAL BENEFIT DUE.","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["NCIS","INVESTIGATIONAL SERVICE, NOT COVERED","N623","Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.","CO","Contractual Obligations","55","Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NCLI","RENDERING PROVIDER MUST PROVIDE CLINICAL INFORMATION FOR THESE SERVICES.  PLEASE SUBMIT TO: MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200, PO BOX 1121, LEWISTON, ME 04243.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NCON","THIS SERVICE IS NOT COVERED UNDER THE PROVIDER'S CONTRACT. THE PATIENT IS NOT RESPONSIBLE.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","147","Provider contracted/negotiated rate expired or not on file."]
["NDDC","NAME OF RENDERING PHYSICIAN AND RENDERING NPI IS REQUIRED FOR CLAIM PROCESSING.  PLEASE RESUBMIT WITH PROVIDER WHO RENDERED SERVICES.","N290","Missing/incomplete/invalid rendering provider primary identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NEAP","SERVICES NOT BILLED WITH APL CODE.  SERVICES MUST BE BILLED ON HCFA.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NEG","THIS IS A NEGOTIATED DISCOUNT. YOU ARE NOT RESPONSIBLE FOR THIS AMOUNT.","","","CO","Contractual Obligations","131","Claim specific negotiated discount."]
["NEM","Non-Emergency Transportation is not covered services under Hoosier Healthwise Package C benefits.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NEMT","Non-Emergency and Group Emergency Transportation claims need to be submitted to HFS directly","N418","Misrouted claim.  See the payer's claim submission instructions.","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["NEUR","MUST BILL NEUROSTIMULATOR IMPLANT DEVICE","MA50","Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NEW","NEWBORN CHARGES HAVE BEEN PROCESSED UNDER THE MOTHER'S ID.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NHLD","ADMINISTRATIVE HOLD REMOVED. CLAIM RECONSIDERED.","N10","Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.","CO","Contractual Obligations","169","Alternate benefit has been provided."]
["NIB","PLEASE SUBMIT AN ITEMIZED BILLTO: MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200, PO BOX 1121, LEWISTON, ME 04243.","N26","Missing itemized bill/statement.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["ONMC","PROCESSED IN ACCORDANCE WITH OUT OF NETWORK REIMBURSEMENT RULES.  SERVICES WITH NO ASSIGNED FEE OR WHICH ARE CONSIDERED INCLUSIVE/PACKAGED WILL RESULT IN $0.00 PAYMENT.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["ONNE","Ordering Provider NPI Not Enrolled","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["ONNI","Ordering Provider NPI Not for Individual","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["OONC","PAID IN ACCORDANCE WITH THE HEALTH PLANS OUT OF NETWORK RULES","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PAOF","Payment Integrity hospital bill audit recovery/recoupment that was identified by the Optum team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PAOP","Payment Integrity hospital bill audit recovery/recoupment that was identified by the Optum team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PC01","SERVICES NOT PROVIDED OR AUTHORIZED BY DESIGNATED PCP (PRIMARY CARE PROVIDER)","N450","Covered only when performed by the primary treating physician or the designee.","CO","Contractual Obligations","242","Services not provided by network/primary care providers."]
["PCDE","THIS EDIT OCCURRED BECAUSE  THE PROCEDURE CODE SUBMITTED IS NOT  VALID FOR THE DATES OF SERVICE ON THIS CLAIM.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["PCED","Provider has been notified to submit completed medical records for the claim to an external vendor as part of a Payment Integrity clinical review.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NCUC","NOT COVERED UNDER THE TERMS OF THIS AGREEMENT","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["NCVS","NONCOVERED VISION CARE SERVICES UNDER THE PLAN.  PATIENT MAY BE RESPONSIBLE UP TO BILLED CHARGES.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["NDCR","THE NDC NUMBER, DRUG NAME, STRENGTH OF PRESCRIPTION AND QUANTITY IS REQUIRED TO COMPLETE REVEIW OF THIS CLAIM.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NMO","Per Illinois Medicaid/HFS Modifier is not billable.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["NMOB","NON-MEDICALLY NECESSARY DELIVERY PRIOR TO 39 WEEKS GESTATION.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NPI","PROVIDER NPI NUMBER IS MISSING AND/OR THE NPI NUMBER SUBMITTED DOES NOT BELONG TO THE PROVIDER ON THE CLAIM.","","","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["NPIN","INDIVIDUAL PROVIDER NPI NUMBER DOES NOT MATCH NAME OF PROVIDER BILLED PER NPPES.","","","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["NPP","ALL EXCLUDED SERVICES SHALL BE PROVIDED BY NETWORK/PARTICIPATING PROVIDER, WHO MUST BILL DIRECTLY FOR COVERED SERVICES.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NID","THE ORIGINAL CLAIM WAS PROCESSED UNDER AN INVALID ID#.  THIS EOP CONTAINS BOTH A NEGATIVE PAYMENT AGAINST THE OLD ID NUMBER AND A POSITIVE REPAYMENT AGAINST THE MEMBER'S NEW ID NUMBER.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["PCID","PCID - Provider has been notified to submit completed medical records for the claim as part of a Payment Integrity clinical review. Please email records to DRGInquiryPI@EvolentHealth.com","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PCMX","PROCESSED PER PARTICIPATING CONTRACT OR FEE SCHEDULE","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["PCP","SERVICES NOT PROVIDED OR AUTHORIZED BY DESIGNATED PCP (PRIMARY CARE PROVIDER)","","","CO","Contractual Obligations","242","Services not provided by network/primary care providers."]
["PD","PER DIEM RATE PAID","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PDIF","Payment Integrity DRG Audit recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PDIP","Payment Integrity DRG Audit recovery/recoupment that was internally identified by the Evolent team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PDOF","Payment Integrity DRG Audit recovery/recoupment that was identified by the Optum team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PDOP","Payment Integrity DRG Audit recovery/recoupment that was identified by the Optum team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PE","PRIMARY INSURANCE PAYMENT IS GREATER THAN OR EQUAL TO HFS/IL MEDICAID PAYABLE BENEFIT. NO ADDITIONAL PAYMENT IS DUE.","","","OA","OA Other adjustments","23","The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)"]
["PE51","SERVICE MUST BE BILLED WITH AN APPROPRIATE REVENUE CODE TO BE ELIGIBLE FOR EAPG REIMBURSEMENT.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PEAP","CLAIM HAS BEEN PRICED PER EAPG CALCULATION.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["PHIF","Payment Integrity high dollar review audit recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PHIP","Payment Integrity high dollar review audit recovery/recoupment that was internally identified by the Evolent team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PHOF","Payment Integrity high dollar review audit recovery/recoupment that was identified by the Optum team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PHOP","Payment Integrity high dollar review audit recovery/recoupment that was identified by the Optum team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PHV","CLAIM HAS BEEN MISDIRECTED FOR NON-PHARMACY SERVICES.","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["PI","PAYMENT FOR SERVICES INCLUDED AS PART OF PER DIEM/DRG","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PID","PRIMARY INSURANCE''S EOB IS LACKING DENIAL REASON FOR NON-PAYMENT OF CLAIM.","N4","Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.","CO","Contractual Obligations","251","The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["PGIF","Payment Integrity Clinical Audit recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim amount. Provider has been notified via determination letter. Additional questions can be sent DRGInquiryPI@EvolentHealth.com","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PIIF","Payment Integrity itemized bill review audit recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PIIP","Payment Integrity itemized bill review audit recovery/recoupment that was internally identified by the Evolent team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PIOF","Payment Integrity itemized bill review audit recovery/recoupment that was identified by the Optum team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PIOP","Payment Integrity itemized bill review audit recovery/recoupment that was identified by the Optum team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PIR","PRIMARY INSURANCE HAS REQUESTED ADDITIONAL INFORMATION BEFORE THEY DETERMINE THEIR PAYMENT.","N36","Claim must meet primary payer's processing requirements before we can consider payment.","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["PIW","PAYMENT BEING HELD AT THE DIRECTION OF HFS","","","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PDCF","Payment Integrity DRG Audit recovery/recoupment that was identified by the Claris team and is a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PDCP","Payment Integrity DRG Audit recovery/recoupment that was identified by the Claris team and is a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","OA","OA Other adjustments","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PMCF","Payment Integrity data mining recovery/recoupment that was identified by the Claris team and is a full take back on the paid claim amount.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PMCP","Payment Integrity data mining recovery/recoupment that was identified by the Claris team and is a partial take back on the paid claim amount.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PMIF","Payment Integrity data mining recovery/recoupment that was internally identified by the Evolent team and is a full take back on the paid claim line amount.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PMIP","Payment Integrity data mining recovery/recoupment that was internally identified by the Evolent team and is a partial take back on the paid claim line amount.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PNEH","Provider not eligible to receive payment per HFS guidance","","","CO","Contractual Obligations","256","Service not payable per managed care contract."]
["PNV","PRENATAL VISIT IS ONLY PAYABLE WITH CODE 0502F.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PO","VERIFY PLACE OF SERVICE AND/OR CPT CODES. INCONSISTANT WITH RELATED CHARGES AND/OR AUTHORIZATION.","","","CO","Contractual Obligations","284","Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services."]
["POAI","THE POA INDICATOR SUBMITTED IS INVALID.  PLEASE REVIEW ALL ICD10 CODE FOR POA APPLICABILITY.  THIS CLAIM CANNOT BE PROCESSED UNTIL A CORRECT CLAIM HAS BEEN RECEIVED.","N434","Missing/Incomplete/Invalid Present on Admission indicator.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["POAM","POA INDICATORS ARE REQUIRED.  PLEASE REVIEW ALL ICD10 CODES FOR POA APPLICABILITY.  THIS CLAIM CANNOT BE PROCESSED UNTIL A CORRECT CLAIM HAS BEEN RECEIVED.","N434","Missing/Incomplete/Invalid Present on Admission indicator.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["POBP","Postpartum Bonus Payment Applied.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["T100","According to CPT Anesthesia Guidelines, only the most complex anesthesia service is reported.","","","CO","Contractual Obligations","269","Anesthesia not covered for this service/procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T101","Payment allowance for a medically directed CRNA or AA is 50% the rate of personally performed","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T102","Per NCCI, separate payment is not allowed for anesthesia services performed by the surgeon","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T103","HCPCS code S2900 represents a service that is considered incidental to the primary service.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T104","It is not appropriate to append modifier 47 to an anesthesia code.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T105","Per NCCI, this service is included in the primary procedure and is not separately reportable.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T180","Eligible for Assistant Surgeon Discount without Surgeon claim available for global surgery amount.","","","CO","Contractual Obligations","131","Claim specific negotiated discount."]
["T186","Per the OPPS, payment is reduced with other procedures for the same dos, diff claim.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T187","Per the OPPS, payment is made at 50% of the fee schedule amount.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T188","Per CMS, payment for the TC component is 80% for additional diagnostic procedures.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T189","Per CMS, payment for the technical component is 75% for additional diagnostic procedures.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T190","Per CMS, payment for the professional component is 75% for additional diagnostic procedures.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T610","Nursing Facility E/M codes must be billed with an appropriate place of service code.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T611","This code is not a valid CPT or HCPCS code.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T612","Per CPT/HCPCS guidelines, this code is allowed to be reported once per its designated time span.","","","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["T613","Per the OPPS, this procedure is designated as an inpatient only procedure.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T614","CPT/HCPCS code not valid for the billed date of service.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T615","This code is incorrect for the service provided","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T616","Per CMS pay one office/outpt visit per patient, per day, unless services are separately identifiable","","","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T617","Per CPT, physicians may not report hydration, injection, or infusion codes in the facility setting.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T618","Per CMS and industry standards, vertebral axial decompression is not a reimburseable service.","","","CO","Contractual Obligations","167","This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T619","HCPCS Code S9088 represents location of service; reimbursement is included in the primary service.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T620","CPT code 64640 is not correct coding methodology for Dx 355.6.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T621","Per HCPCS and CMS, modifier SU is informational only with no additional payment allowed.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["T622","Only one unit of service is allowed for implant removals.","","","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["T623","This Px should be billed with POS 24 when performed in an ASC.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T624","POS 11 incorrect on a prof. clm; rec amt adjusted on this ASC claim, sm TIN.","","","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T625","This procedure should be billed with POS 22 when performed in an outpatient hospital setting.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T626","Invalid POS for hosp outpt service on CMS1500 was previously paid; Rec Amt adjusted on this UB claim","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T627","HCPCS code S9083 is a global service; payment is based on other billed srvcs.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T628","Code S9083 describes all services in an urgent care visit; addl srv denied.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T640","Per CPT/HCPCS guidelines, this code is allowed to be reported once per 2 days.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T641","Per CPT/HCPCS guidelines, this code is allowed to be reported once per 7 days.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T642","Per CPT/HCPCS guidelines, this code is allowed to be reported once per 14 days.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T643","Per CPT/HCPCS guidelines, this code is allowed to be reported once per 21 days.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T644","Per CPT/HCPCS guidelines, this code is allowed to be reported once per 30 days.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T645","Per CPT/HCPCS guidelines, this code is allowed to be reported once per 90 days.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T646","Per CPT/HCPCS guidelines, this code is allowed to be reported once per 365 days.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T667","Per CPT code may not be billed in conjunction with other specified code","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T668","Per CPT coding guidelines, the patient's age is outside the age parameters for the code.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T669","Per CPT coding guidelines, the gender for the code does not match the gender on the claim.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T670","Per CPT coding guidelines, this code is bundled when other services are provided on the same DOS.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["T673","Modifier 22 is inappropriate with this procedure code.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T674","Modifier 22 is not approved for facility billing.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T675","The modifier is incorrect for the service provided.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T676","A required modifier is missing","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T680","This service is considered non-covered; it is not eligible for reimbursement.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T681","Per State Medicaid guidelines the POS code billed is not appropriate with this procedure code.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T706","Per NCCI, closure of the surgical incision is included in payment for the procedure.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T708","It is not appropriate to bill a Separate Procedure with another related service.","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T715","This service is part of a clinical trial. It is not appropriate to bill for these services.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T800","NCCI disallows this procedure with other procedure(s) billed same DOS, without an NCCI anatomic mod","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T801","NCCI disallows this procedure billed with a procedure same DOS, diff claim w/o an NCCI anatomic mod","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T802","NCCI disallows this procedure with other procedure(s) billed for same DOS, without an NCCI modifier","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T803","NCCI disallows this procedure with another procedure billed for the same DOS, with or w/o a modifier","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T804","NCCI disallows this procedure with a procedure billed on a diff claim, same DOS, without an NCCI mod","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T805","NCCI disallows this procedure with another procedure billed on a different claim for the same DOS","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T806","NCCI disallows this procedure with another procedure billed for same DOS, without an NCCI modifier","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T807","NCCI disallows this procedure with another procedure billed for the same DOS, with or w/o a modifier","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T808","NCCI disallows this procedure with a procedure billed on a diff claim, same DOS, without an NCCI mod","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T809","NCCI disallows this procedure with another procedure billed on a different claim for the same DOS","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T812","Per CPT /CMS correct coding, this unmodified srvc is disallowed.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T813","Per CPT /CMS correct coding, this srvce is disallowed w or w/o a modifier.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T814","Per CPT/CMS, this service is disallowed with a service on a dif clm w/o mod.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T815","Per CPT/CMS, this service is disallowed with a service billed on a dif clm.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","P14","The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only."]
["T816","Per NCCI policy, this code is bundled with another code on this claim.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","P14","The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only."]
["T817","Per NCCI policy, this code is bundled with a code on another claim.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","P14","The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only."]
["T818","Per NCCI policy, this code is reduced due to a related code on another claim.","","","CO","Contractual Obligations","B10","Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test."]
["T824","NCCI bundles a previously paid procedure w/o NCCI mod into this procedure; Rec Amt has been adjusted","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T825","NCCI bundles a previously paid procedure into this procedure; Rec Amt has been adjusted accordingly","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T828","NCCI bundles a previously paid procedure w/o NCCI mod into this procedure; Rec Amt has been adjusted","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T829","NCCI bundles a previously paid procedure into this procedure; Rec Amt has been adjusted accordingly","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T830","NCCI: The total units for this procedure on this claim for the same DOS are medically unlikely.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T831","NCCI: The total units for this procedure across claims for the same DOS are medically unlikely.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T834","NCCI: The total units for this procedure on this claim line for the same DOS are medically unlikely.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T850","This once-in-a-lifetime procedure was billed twice on this claim with different DOS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T851","This once-in-a-lifetime procedure was previously billed for a different DOS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["UEX","PAYMENT ADJUSTED TO ALLOW NUMBER OF UNITS/VISITS APPROVED","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","198","Precertification/notification/authorization/pre-treatment exceeded."]
["UIC","UIC PROVIDER - TIN 376000511 - HANDLED BY DIFFERENT MSO.","","","co","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["PODN","REIMBURSEMENT NOT SUPPORTED BY CONTRACT","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["PPC","PROVIDER PREVENTABLE CONDITIONS ARE INELIGIBLE FOR BENEFIT","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","167","This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PPIR","Potentially Preventable Inpatient Readmission within 30 days","","","CO","Contractual Obligations","249","This claim has been identified as a readmission. (Use only with Group Code CO)"]
["PPOI","OON PROVIDER PROCESSED IN NET BENEFITS","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["PRA","\"Readmission Denial Overturned; Payment Allowed\"","N561","The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["SEOB","PRIMARY INSURANCE  EOB RECEIVED. PLEASE SUBMIT A COPY OF THE SECONDARY INSURANCE EXPLANATION OF PAYMENT.","MA64","Our 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.","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["SFT","THE SERVICE FROM DATE IS GREATER THAN THE SERVICE TO DATE.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["SIP","PREAUTHORIZATION REQUIRED-INPATIENT STAY","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["SKI","APPLICATION OF SKIN SUBSTITUTE MUST BE BILLED","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["SM%","PAYMENT HAS BEEN REDUCED DUE TO THE PRICING MODIFIER SUBMITTED.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["SNC","SERVICE NOT COVERED UNDER SPECIAL NEEDS CHILDREN PLAN","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["SP25","SP 25 UPGRADE TESTING","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["SS01","SUBMITTED SPECIALTY DOES NOT MATCH OR TAXONOMY MISSING AND MUST BE SUBMITTED ON CLAIM.","N288","Missing/incomplete/invalid rendering provider taxonomy.","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T000","Per CPT manual instructions, physicians may not charge for Category II tracking codes.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T001","Per HCPCS manual instructions, physicians may not charge for quality reporting codes.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T002","According to the National Physician Fee Schedule, payment for this service is always bundled.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T050","This service is not appropriate for reimbursement on this DOS.","N56","Procedure code billed is not correct/valid for the services billed or the date of service billed.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T051","This service is bundled into another service rendered at the same time.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["UNLD","UNLISTED PROCEDURE CODE RECORDS REVIEWED, DENIAL UPHELD.","","","CO","Contractual Obligations","189","Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service"]
["UPSD","UNUSUAL PROCEDURE SERVICE REVIEWED AND DENIED.  PLEASE SUBMIT ADDITIONAL DOCUMENTATION ON WHY THIS IS AN UNUSUAL PROCEDURE FOR ADDITIONAL REVIEW.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","189","Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service"]
["SYSI","THIS DUPLICATE CLAIM WAS GENERATED AS THE RESULT OF A SYSTEMS ISSUE AND IS BEING PROCESSED AS AN ADMINISTRATIVE DENIAL ONLY.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["VAC","VACCINE AND ADMIN CODE MUST BE BILLED TOGETHER","N349","The administration method and drug must be reported to adjudicate this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["VIRT","G2012 MUST BE BILLED SEPARATELY FROM ENCOUNTER CODE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["VIS1","ONE EYE EXAM PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["VIS2","ONE EYE EXAM EVERY 2 YEARS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["VNC","VISION IS NOT A COVERED BENEFIT.","N216","We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["VSHD","VISION HARDWARE IS NOT SEPARATELY PAYABLE.","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["VSP","SERVICES SHOULD BE SUBMITTED TO THE VISION VENDOR FOR CONSIDERATION.","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["VDOS","PLEASE VERIFY DATE OF SERVICE WAS BILLED CORRECTLY VERSES ALL OTHER DATES OF SERVICE BILLED.","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["WATY","CLAIM DOES NOT FOLLOW HFS ATYPICAL BILLING GUIDELINES","","","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["WH","WITHHOLD - 19%","","","CO","Contractual Obligations","104","Managed care withholding."]
["WRED","25% WITHOLD REDUCTION APPLIES","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["WTAK","25% WITHHOLD DEDUCTION TAKEN ON CLAIM","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["R942","REVENUE CODE 0942 CAN ONLY BE BILLED BY LTC PROVIDERS PER HFS GUIDELINES. PLEASE RESUBMIT YOUR CLAIM WITHOUT USING REVENUE CODE 0942.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["RAD","RADIOLOGY WITH CONTRAST PROCEDURE MUST BE BILLED WITH CONTRAST MATERIAL","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["RAR","CLAIM REPROCESSED DUE TO RETRO ELIGIBILITY RECEIVED.","MA67","Alert: Correction to a prior claim.","CO","Contractual Obligations","169","Alternate benefit has been provided."]
["RCOD","RECONSIDERATION REQUEST DENIED; NO AUTHORIZATION RECEIVED","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["RCON","RECONSIDERATION REQUEST REVIEWED, NO FURTHER BENEFIT PAYABLE","","","CO","Contractual Obligations","193","Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly."]
["RCOP","CLAIM HAS BEEN REPROCESSED DUE TO DEDUCTIBLE AND/OR OUT OF POCKET MET.  REFUND MAY BE OWED TO PATIENT.  QUESTIONS? 1-855-624-6463.","","","OA","OA Other adjustments","2","Coinsurance Amount"]
["RCPX","PROVIDER IS NOT ELIGIBLE FOR THIS MEMBER UNDER THE RIGHT CHOICE PROGRAM.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","184","The prescribing/ordering provider is not eligible to prescribe/order the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["RDP","RECEIVED DATE IS PRIOR TO DATE OF SERVICE.","","","CO","Contractual Obligations","110","Billing date predates service date."]
["RCPA","RECONSIDERATION REQUEST HAS BEEN RECEIVED AND REVIEWED; ADDITIONAL PAYMENT IS WARRANTED","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["RKX","THE PLAN DOES NOT PROVIDE BENEFITS FOR REFRACTIVE EYE SURGERY.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["RNC","RENTAL OF SUPPLY NOT ELIGIBLE. THIS SUPPLY CAN ONLY BE PURCHASED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["RNNI","Referring Provider NPI Not for Individual","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["RORP","ALERT (ORP): Entity''s National Provider Identifier (NPI). Missing or invalid information.","N31","Missing/incomplete/invalid prescribing provider identifier.","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["RQ50","SUBMITTED COST IS REQUIRED.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["RQME","SUBMITTED MODIFIER NOT ACTIVE.","","","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["RRC","PURCHASE OF SUPPLY NOT ELIGIBLE. THIS SUPPLY CAN ONLY BE RENTED.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["RPNE","Referring Provider NPI Not Enrolled","N433","Resubmit this claim using only your National Provider Identifier (NPI).","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["RPPD","REF PROV NOT FOUND-PLAN DIRECTED CARE","N286","Missing/incomplete/invalid referring provider primary identifier.","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["RVAG","THE REVENUE CODE SUBMITTED IS NOT APPROPRIATE FOR THE AGE OF THE PATIENT.","","","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["UC","PROCESSED ACCORDING TO USUAL AND CUSTOMARY.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T200","Reimbursement for assistant surgeon services is paid at 16% of the global surgery amount.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T201","This procedure is not eligible for assistant surgeon reimbursement.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T202","This global obstetric care code is not eligible for assistant surgeon reimbursement.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T203","Per Nat'l Phys Fee Sched this procedure is bilateral and priced at 150% of the fee schedule amount","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T204","Per Nat'l Phys Fee Sched, this procedure is eligible for bilateral and multiple procedure discounts.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T205","This procedure is eligible for assistant surgeon and multiple procedure discounts.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T206","This code can never serve as a stand-alone code and must be reported in addition to a primary code","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T207","According to the Nat'l Phys Fee Sched this procedure is not eligible for Co-Surgeon reimbursement","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T208","Per National Physician Fee Schedule this procedure is not eligible for Team Surgeon reimbursement","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T209","Per Natâ\u0080\u0099l Phys Fee Sched, documentation is required to establish medical necessity for Co-Surgeon.","M25","The 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 an 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.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T210","Per CPT, this procedure is inherently bilateral; pay 100% for one unit.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T211","Routine supplies are included in the primary service and are not separately billable.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["T212","Supplies associated with denied services are also denied.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T213","When the primary code is denied, the associated add-on code is also denied.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T214","This service is included in the global obstetric care service and should not be reported separately.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T215","Per CPT coding guidelines this service is included in the surgical package; do not report separately","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T216","Per Nat'l Phys Fee Sched this procedure is inherently bilateral; pay 100% fee sched amt for one unit","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T217","Per CPT, Supplies used during infusions/injections are included in the administration codes.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T218","Per CPT, Supplies used for irrigation are not separately reportable.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T219","The Rec. amount for this global OB code was adjusted due to previously billed antepartum visits.","M80","Not covered when performed during the same session/date as a previously processed service for the patient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T220","Per HCPCS, all necessary supplies are included in the Home Therapy codes.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T221","Per HCPCS, ambulance service codes include basic supplies and services.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T222","Separate reporting of an administration code is not allowed with this service.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T230","Per State Medicaid guidelines, this procedure is not eligible for assistant surgeon reimbursement.","","","CO","Contractual Obligations","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T231","Per State Medicaid guidelines, this procedure is not eligible for co-surgeon reimbursement.","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["T232","Per State Medicaid guidelines, this procedure is not eligible for team surgeon reimbursement.","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["T240","This code is subject to the assistant surgeon reimbursement rules.","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T241","This code is subject to the co-surgeon reimbursement rules.","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T242","This code is subject to the team surgeon reimbursement rules.","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T250","This code is subject to the multiple procedure reimbursement rules.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T255","This code is subject to the bilateral procedure reimbursement rules","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T260","Only one antepartum multi-visit code should be billed per pregnancy.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T290","Medicaid Regulations indicate this service is included in the Global Surgical Package","N390","This service/report cannot be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T298","According to the CMS, this service is included as part of the pre-operative Global Surgical Package","N390","This service/report cannot be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T299","According to CMS, this service is included as part of the post-operative Global Surgical Package","N390","This service/report cannot be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T300","Per Nat'l Phys Fee Schedule, physicians may not bill global services in a facility setting","","","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T360","CPT code 36000 is integral to a more extensive service performed.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T400","Per CMS, only one lab may bill for a reference test.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T401","This automated lab test is not eligible for separate professional payment.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T404","Payment is denied for all individual components of an Organ or Disease Panel code.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T406","Per CPT, this lab panel code is adjusted because of individual test code(s) billed on a diff claim.","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T407","Per CPT, this individual test code is included in payment for the Organ or Disease Oriented Panel.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T408","Per Nat'l Phys Fee Sched, this lab code is not eligible for separate professional component payment","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T414","Per CPT, this service may only be reported once per delivery.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["T450","Per code descriptors, G0101 is included in the preventive med. visit sm DOS","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T500","This service is bundled into another service rendered at the same time.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T502","Payment for this service is bundled into the Critical Care code.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T510","Per HCPCS, C-codes should only be used by an OPPS facility.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T599","This online eval code is denied within 7 days after a related E/M Service.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T600","New patient visit not appropriate-patient received professional services from provider within 3 yrs.","","","CO","Contractual Obligations","B16","New Patient' qualifications were not met."]
["T601","Two hospital visits on the same day by the same provider for the same patient are not reimbursable.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T602","Only an initial hospital care service or an inpatient consultation is allowed on the same DOS","","","CO","Contractual Obligations","B14","Only one visit or consultation per physician per day is covered."]
["T603","This Evaluation and Management service is considered included in the hospital E/M service.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T605","Emergency Department E/M codes must be billed with the Emergency Department place of service code 23","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T606","Only one unit of service may be billed with this code per a given date of service.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["T608","Custodial Care E/M codes must be billed with an appropriate place of service code.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T609","Home Services E/M codes must be billed with a place of service code 12.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T860","Per CCI, all types of repairs are included in benign lesion removals of 0.5 cm or less.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T861","Per NCCI, an incidental appendectomy is not separately reportable.","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["T865","Per AAOS, this procedure is included in a more global procedure provided on the same DOS","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T872","Medicaid disallows this service with another service w/ same DOS, w/o a modifier","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T873","Medicaid disallows this service with another service w/ same DOS, with or w/o modifier","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T874","Medicaid disallows this service with a service billed on a diff claim, same DOS, w/o an approved mod","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T875","Medicaid disallows this service w/another service on a diff claim w/same DOS with or w/o a modifier","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["T876","Medicaid bundles a previously paid service w/o a mod into this procedure; Rec Amt has been adjusted","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T877","Medicaid bundles previously paid service into this service; Rec amnt has been adjusted accordingly.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T981","Service/procedure appears duplicative of a previously paid CMS1500 claim for the same DOS","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T982","This service/procedure is a duplicate of a previously paid UB claim for the same date of service.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T991","Service/procedure appears duplicative of a previously reviewed CMS1500 claim for the same DOS","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T992","Service/procedure appears duplicative of a previously reviewed UB claim for the same date of service","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T993","This service/procedure appears to be a duplicate to another line on this professional claim.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["TAMB","Taxonomy not within state transportation guidelines Eff: 1/1/17","","","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["TB01","Per Phys Fee Schedule, payment is not allowed for this Status B code.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["TC3","THIS CLAIM HAS BEEN RETROACTIVELY DENIED, PENDING AN OUTSTANDING REQUEST FOR FURTHER DOCUMENTATION.  PLEASE SUBMIT PREVIOUSLY REQUESTED DOCUMENTATION FOR THIS CLAIM TO:  TC3 HEALTH ATTN:  CODING OPERATIONS 5720 SMETANA DRIVE, SUITE 400 MINNETONKA, MN 55343.  IF YOU HAVE ANY QUESTIONS REGARDING THE REQUESTED DOCUEMNTATION, PLEASE CALL EMDEON'S PROVIDER SERVICES LINE AT 855-277-9350.","MA130","Your 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.","CO","Contractual Obligations","129","Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["TC3P","INSUFFICIENT DOCUMENTATION RECEIVED TO VERIFY SERVICES.","N705","Incomplete/invalid documentation.","CO","Contractual Obligations","251","The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["TCMB","Taxonomy & claim text note not within state transportation guidelines Eff: 1/1/17","","","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["SAS","SURGEON AND ASSISTANT SURGEON MUST BILL SEPARATELY.","N61","Rebill services on separate claims.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["SCN","MAXIMUM BENFT EXCEEDED. SMOKING CESSATION MAXIMIMUM 12 WEEK COURSE OF TREATMENT PER MEMBER PER CALENDAR YEAR","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["SCR","SEPARATE CLAIM REQUIRED FOR EACH PROVIDER BILLING SERVICES.","N61","Rebill services on separate claims.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["SCY","PLEASE SUBMIT CORRECTED CLAIMS FOR SERVICES RENDERED FOR EACH CALENDAR YEAR SEPARATELY.","","","CO","Contractual Obligations","268","The Claim spans two calendar years. Please resubmit one claim per calendar year."]
["T191","Per CMS, payment for the prof. component is 75% w/additional Dx procedures found on another claim.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T194","Per CMS, payment for the technical component is 50% for additional diagnostic procedures.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T195","Per CMS, payment for the tech. component is 50% w/additional Dx procedures found on another claim.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T197","Reimbursement for assistant surgeon services is paid at 20% of the global surgery amount.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T198","Per Natâ\u0080\u0099l Phys Fee Schedule, payment is reduced with other procedures for the same dos, diff claim.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["T199","According to the National Physician Fee Schedule, payment is made at 50% of the fee schedule amount.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["TEOB","PLEASE SUBMIT A COPY OF THE PRIMARY AND SECONDARY EOB''S.","MA64","Our 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.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["TF","APPEAL DENIED THE DOCUMENTATION SUBMITTED DOES NOT PROVIDE EVIDENCE OF TIMELY FILING.","","","CO","Contractual Obligations","164","Attachment/other documentation referenced on the claim was not received in a timely fashion."]
["TFA","THE ISSUE OF NON TIMELY FILING MUST BE DIPUTED/APPEALED WITH THE PRIMARY INSURANCE CARRIER AS THEY WERE PRIMARY AT THE TIME OF SERVICE.","","","CO","Contractual Obligations","138","Appeal procedures not followed or time limits not met."]
["TH60","COMBINED THERAPY SERVICES (PT/OT/ST/RESPIRATORY/CARDIAC) LIMITED TO 60 VISITS PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["TH75","COMBINED THERAPY SERVICES (PT/OT/ST/CARDIAC/RESPIRATORY) LIMITED TO 75 VISITS PER YEAR.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["THNA","SERVICES DENIED. THERAPY NOT AUTHORIZED.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["TIN","PROVIDER BILLING WITH INVALID TIN. PLEASE SUBMIT CORRECTED BILLING.","N289","Missing/incomplete/invalid rendering provider name.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC00","A 208.00 PER UNIT VENT ADD-ON APPLIES TO THIS SERVICE","","","CO","Contractual Obligations","91","Dispensing fee adjustment."]
["58","TREATMENT WAS DEEMED BY THE PAYER TO HAVE BEEN RENDERED IN AN INAPPROPRIATE OR INVALID PLACE OF SERVICE.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["TMJX","TREATMENT FOR TMJ IS NOT COVERED UNDER THE PLAN.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["TN","TAX ID NUMBER NOT ON FILE FOR THIS PROVIDER","N209","Missing/incomplete/invalid taxpayer identification number (TIN).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["TNA","SERVICES OVER 8 VISITS REQUIRE AUTHORIZATION.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["TRAN","BLOOD PRODUCT MUST BE BILLED","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["TST","when 80050 is not billed on the same day as 99213","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["TT01","Per Phys Fee Sched, separate payment is disallowed for this code Status T code.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["U58","A CLAIM WAS RECEIVED FOR SERVICES THAT CANNOT BE BILLED BY THIS PROVIDER TYPE.","N238","Incomplete/invalid physician certified plan of care.","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ12","Professional DASA/SUPR services billed with unacceptable primary diagnosis. Acceptable primary diagnosis codes: F10-F19.99","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ13","U2 MODIFIER IS ONLY ALLOWED FOR HOME HEALTH SERVICES.","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ14","U2 MODIFIER IS ONLY ALLOWED FOR HOME HEALTH SERVICES.","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ15","PREVENTIVE SERVICES ARE NOT SEPARATELY REIMBURSABLE WHEN BILLED WITH AN E&M CODE.","N20","Service not payable with other service rendered on the same date.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ02","SERVICES PRICED OUTSIDE OF SUPR/DASA SPECIFIC FEE SCHEDULES ARE NOT ALLOWED.","N643","The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ30","Acupuncture services are not payable when billed without the required diagnosis codes or when billed by provider other than an acupuncturist.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ37","Procedure code 99401 with modifier FP is reimbursed to provider registered with category of service 103.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","185","The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ43","A $481.00 per unit vent add-on is applicable","","","CO","Contractual Obligations","91","Dispensing fee adjustment."]
["XQ65","PROVIDER NOT BILLING PER DSMES BILLING GUIDELINE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["XQ67","Claim is billed with procedure codes not payable under CCBHC billing guidelines.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["XQ68","Incorrect billing taxonomy for CCBHC services","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["XQ69","Provider type or category of service is not payable for CCBHC services","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["XP58","Interim claims must bill through end of service month.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y930","INPATIENT CLAIMS REQUIRE VALID ROOM AND BOARD REVENUE CODES.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y932","LIMITS 552 UNITS PER MONTH-S9122","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y933","THE PROCEDURE WAS PRICED ACCORDING TO PARTIAL HOSPITALIZATION APPROXIMATION.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y934","REVENUE CODES 510-529, OR ANY SUCCESSOR CODES, SHALL NOT BE REIMBURSED, UNLESS THERE IS A CONTRACTUAL REQUIREMENT TO DO SO.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y935","DME CODE BILLED WITHOUT A MODIFIER.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y936","INTENSIVE BEHAVIORIAL THERAPY (IBT) FOR CARDIOVASCULAR DISEASE (CVD) (G0446)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y937","PREVENTIVE AND SCREENING SERVICES - PROCEDURE FREQUENCY - 2","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y938","PREVENTIVE AND SCREENING SERVICES - PROCEDURE FREQUENCY - 3","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y939","PATIENT IS INCARCERATED","N30","Patient ineligible for this service.","CO","Contractual Obligations","258","Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service."]
["Y950","INVALID NDC TO PROCEDURE CODE COMBINATION.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y951","PER KY MEDICAID DME LIMITS, CLAIM HISTORY COUNT OF IS GREATER THAN THE LIMIT OF ALLOWED.","N435","Exceeds number/frequency approved /allowed within time period without support documentation.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["Y952","A MULTIPLE PROCEDURE REDUCTION OF APPLIES TO THE PROCEDURE CODE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["ZAD","PLEASE RESUBMIT THIS CLAIM WITH THE CORRECT ADMIT AND DISCHARGE DATES","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZAP","PLEASE RESUBMIT CLAIM WITH THE NAME OF THE ATTENDING PHYSICIAN","N252","Missing/incomplete/invalid attending provider name.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZCOB","OTHER INSURANCE INFORMATION HAS NOT BEEN RECEIVED","N479","Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["ZDDC","DUPLICATE DIAGNOSIS CODE SUBMITTED.  PLEASE RESUBMIT A CORRECTED CLAIM","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y940","THIS PROCEDURE CODE INDICATES THAT MULTIPLE SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y941","THIS PROCEDURE CODE INDICATES THAT MULTIPLE SURGERY SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y942","THIS PROCEDURE CODE NDICATES THAT MULTIPLE DIAGNOSTIC RADIOLOGY SERVICES WERE PERFORMED. PER CMS, A REDUCTION OF APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y943","THIS PROCEDURE CODE INDICATES THAT MULTIPLE DIAGNOSTIC CARDIOVASCULAR SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y944","THIS PROCEDURE CODE INDICATES THAT MULTIPLE DIAGNOSTIC OPHTHALMOLOGY SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y945","THIS PROCEDURE CODE QUALIFIES FOR A MULTIPLE ENDOSCOPY REDUCTION AND PAYMENT SHOULD BE REDUCED TO BY VALUE OF BASE ENDOSCOPY CODE . THE RVU VALUE CODE FOR THIS LINE SHOULD BE REDUCED BY THE RVU VALUE FOR THE BASE ENDOSCOPY.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y946","THIS PROCEDURE CODE IS A BASE ENDOSCOPIC PROCEDURE BILLED WITH OTHER ENDOSCOPIC PROCEDURES AND IS NOT ELLIGIBLE FOR ADDITIONAL REIMBURSEMENT.","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y947","TAXONOMY FOR NPI ON THIS CLAIM IS NOT COVERED BY MEDICARE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y948","PER CCI GUIDELINES (INSTITUTIONAL), PROCEDURE CODE HAS BEEN BILLED OUT OF SEQUENCE WITH PROCEDURE CODE ON CLAIM NUMBER IN HISTORY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y949","PER CCI GUIDELINES (PHYSICIAN), PROCEDURE CODE HAS BEEN BILLED OUT OF SEQUENCE WITH PROCEDURE CODE ON CLAIM NUMBER IN HISTORY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZDPA","DEPENDENT OVER AGE LIMIT.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","32","Our records indicate the patient is not an eligible dependent."]
["ZFBB","THE TYPE OF BILL CODE IS INVALID. PLEASE RESUBMIT THIS CLAIM WITH A CORRECTED CODE.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZFFB","THE TYPE OF BILL CODE IS INVALID.  PLEASE RESUBMIT THIS CLAIM WITH A CORRECTED CODE","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZFT","PLEASE RESUBMIT THIS CLAIM WITH THE CORRECT FROM AND TO DATES","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZITN","INVALID TOOTH NUMBER","N37","Missing/incomplete/invalid tooth number/letter.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZSN","MINIMUM OR MAXIMUM NUMBER OF SURFACES REQUIRED","N75","Missing/incomplete/invalid tooth surface information.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZSPA","SPOUSE OVER AGE LIMIT.","N30","Patient ineligible for this service.","CO","Contractual Obligations","177","Patient has not met the required eligibility requirements."]
["ZTNR","TOOTH NUMBER IS REQUIRED FOR THIS PROCEDURE","N37","Missing/incomplete/invalid tooth number/letter.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZMD","MAXIMUM DEDUCTIBLE FOR THIS TIME PERIOD HAS BEEN REACHED.","","","OA","OA Other adjustments","1","Deductible Amount"]
["ZMDC","MEDICARE'S APPROVED AMOUNT IS LESS THAN $0.  PLEASE RESUBMIT A CORRECTED MEDICARE STATEMENT","N479","Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZMDE","THE MAXIMUM DAYS SUPPLY  FOR THIS ITEM HAS BEEN USED","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["ZMDI","MODIFIER SUBMITTED IS INVALID.","","","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["ZMDO","THE MAXIMUM DAYS FOR THIS ITEM/SERVICE HAS BEEN USED","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["ZMDS","THE MINIMUM DAYS SUPPLY REQUIRED HAS NOT BEEN MET","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ZMFO","THE MAXIMUM FILLS FOR THIS ITEM HAVE BEEN USED","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["ZMNA","MEMBER WAS NOT ACTIVE FOR THE FULL TIME PERIOD OF THIS CLAIM","","","PR","PR Patient Responsibility","200","Expenses incurred during lapse in coverage"]
["ZMQE","THE MAXIMUM QUANTITY ALLOWED HAS BEEN USED","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["ZMQO","THE MAXIMUM QUANTITY FOR THIS ITEM/SERVICE HAS BEEN USED","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["ZMQR","THE MINIMUM QUANITY REQUIRED HAS NOT BEEN MET","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ZNPW","SERVICES ARE NOT ELIGIBLE AS YOUR WAITING PERIOD HAS NOT BEEN COMPLETED","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ZOOP","OUT OF POCKET FOR THIS TIME PERIOD HAS BEEN REACHED","","","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["Y928","SUBMIT CHARGES TO MEDICAID FFS PROGRAM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y929","PRICE WITH CAPITATION","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YAMB","Y'' Indicator missing from box 24C not within state transportation guidelines Eff: 1/1/17","M83","Service is not covered unless the patient is classified as at high risk.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ZPPH","PREAUTHORIZATION IS REQUIRED FOR THIS SERVICE","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["ZPX","THESE ARE NON-COVERED SERVICES BECAUSE THIS IS A PRE-EXISTING CONDITION","N30","Patient ineligible for this service.","CO","Contractual Obligations","51","These are non-covered services because this is a pre-existing condition. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ZQDN","QUADRANT DOES NOT MATCH SPECIFIED TOOTH.","N37","Missing/incomplete/invalid tooth number/letter.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ZQUA","QUADRANT REQUIRED FOR PROCEDURE.","N37","Missing/incomplete/invalid tooth number/letter.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EV17","DEPENDENT OVER AGE LIMIT.","N129","Not eligible due to the patient's age.","OA","OA Other adjustments","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["49","THESE ARE NON-COVERED SERVICES BECAUSE THIS IS A ROUTINE EXAM OR SCREENING PROCEDURE DONE IN CONJUNCTION WITH A ROUTINE EXAM.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","49","This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EPA","CLAIM PAYMENT HAS BEEN ADJUSTED PER EQUIAN ITEMIZED BILL REVIEW. FOR ADDITIONAL INFORMATION, PLEASE CONTACT EQUIAN AT 800-304-5649","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["EPB","CLAIM PAYMENT HAS BEEN ADJUSTED PER OPTUM HIGH DOLLAR REVIEW. FOR ADDITIONAL INFORMATION, PLEASE CONTACT OPTUM AT 949-336-486","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["EPGF","Progeny NICU claim medical records have been reviewed and an overpayment has been identified resulting in a full take back on the paid claim amount.","N35","Program integrity/utilization review decision.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["EPGP","Progeny NICU claim medical records have been reviewed and an overpayment has been identified resulting in a partial take back on the paid claim amount.","N35","Program integrity/utilization review decision.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ESP","ENDOSCOPIC CALCULATIONS WERE APPLIED TO THIS CLAIM.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NUB","INCORRECT BILL TYPE, PLEASE RESUBMIT ON A CMS 1500 FORM. PER HFS CLINICAL VISITS SHOULD NOT BE BILLED ON UB CLAIM FORM.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DME9","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 9 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DNX","PLAN DOES NOT PROVIDE BENEFITS FOR DENTAL SERVICES.","N418","Misrouted claim.  See the payer's claim submission instructions.","OA","OA Other adjustments","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["DPEC","ONLY ONE ENCOUNTER FEE IS PAYABLE PER DAY.","","","CO","Contractual Obligations","B14","Only one visit or consultation per physician per day is covered."]
["18","DUPLICATE CLAIM/SERVICE.","N111","No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["166","THESE SERVICES WERE SUBMITTED AFTER THIS PAYERS RESPONSIBILITY FOR PROCESSING CLAIMS UNDER THIS PLAN ENDED.","N30","Patient ineligible for this service.","OA","OA Other adjustments","166","These services were submitted after this payers responsibility for processing claims under this plan ended."]
["22","THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS.","","","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["D23","SERVICE DENIED -  SERVICE IS NOT A COVERED BENEFIT.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["231","MUTUALLY EXCLUSIVE PROCEDURES CANNOT BE DONE IN THE SAME DAY/SETTING.","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["200D","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 200 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["B12D","CBC TEST RESULTS PERFORMED WITHIN THE PAST 30 DAYS MUST BE ATTACHED TO THE CLAIM WHEN CHARGES ARE SUBMITTED FOR VITAMIN B12 OR FOLIC ACID TESTING.","M30","Missing pathology report.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["MNCP","SERVICES NOT COVERED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["55","PROCEDURE/TREATMENT IS DEEMED EXPERIMENTAL/INVESTIGATIONAL BY THE PAYER.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","OA","OA Other adjustments","55","Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["7","THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S GENDER.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["R780","0780 Revenue code invalid for inpatient claims.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IA11","ASSISTANT SURGEON NOT REQUIRED FOR THIS PROCEDURE.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["A39","APL/HCPCS CODE REQUIRED ON CLAIM","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["A8","UNGROUPABLE DRG.","","","CO","Contractual Obligations","A8","Ungroupable DRG."]
["IAD1","The Admit Diagnosis code is invalid and not found on the table of valid ICD-9 CM Codes.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IAD2","The Admit Diagnosis code is invalid: Invalid code, unnecessary 4th/5th digit.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IAD3","The Admit Diagnosis code is invalid: missing 4th/5th digit.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IAD4","Admit Diagnosis code invalid: Code invalid; found on ICD-9-CM table, but not valid for patient's admission date.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IAD5","The Admit Diagnosis code is invalid: Invalid code for date of admission, unnecessary 4th/5th digit.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IAD6","Admit Diagnosis code invalid: Invalid code for date of admission, missing 4th/5th digit.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IADM","INVALID ADMIT DIAGNOSIS. MISSING NECESSARY ADDITIONAL DIGITS.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IADU","INVALID ADMIT DIAGNOSIS. INCLUDES UNNECESSARY DIGITS.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NAMB","CLAIM SUBMITTED NOT FOLLOWING TRANSPORTATION GUIDELINES AS DEFINED BY HFS.","","","OA","OA Other adjustments","272","Coverage/program guidelines were not met."]
["AMID","MISSING OR INVALID MEDICAID ID FOR ATTENDING PROVIDER BILLED","N253","Missing/incomplete/invalid attending provider primary identifier.","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["ANE","Emergent Services billed but emergency indicator not checked.  Please resubmit claim with IHCP compliant billing process.","N272","Missing/incomplete/invalid other payer attending provider identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IANM","ANESTHESIA CODE REQUIRES APPROPRIATE MODIFIER","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["APNF","Attending Provider Not Found","N253","Missing/incomplete/invalid attending provider primary identifier.","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["APP","Non-Emergency Transportation or Transportation Service unrelated to pregnancy are not covered services under Hoosier Healthwise Package P.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["IASC","PRIMARY SURGICAL PROCEDURE TYPICALLY PERFORMED IN AN AMBULATORY SURGICAL CENTER.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IASD","More than one anesthesia procedure has been billed for the same date of service. Only the anesthesia code with the higher base unit value should be billed per operative session.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IASH","ONLY HIGHER BASE UNIT VALUE ANESTHESIA CODE SHOULDE BE BILLED PER PROCEDURE.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["AUT","MEMBER EXCEEDS AGE LIMIT FOR TREATMENT OF THIS CONDITION","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["BCR","CLAIM HAS BEEN MISDIRECTED.  FOR BEHAVIORAL HEALTH DATES OF SERVICE PRIOR TO 10/15/14 PLEASE SUBMIT CLAIM TO BEACON HEALTH STRATEGIES FOR CONSIDERATION - BEHAVIORAL HEALTH MAIL STOP 300; P.O. BOX 1121 LEWISTON, ME 04243 OR USE EMDEON PAYOR ID 43324.","N418","Misrouted claim.  See the payer's claim submission instructions.","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["IBDS","SERVICE DATE IS MISSING, INVALID, OR NOT WITHIN THE DATE SPAN ON CLAIM.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IBFR","FREQUENCY DOES NOT MEET POLICY REQUIREMENTS FOR THIS PROCEDURE","N435","Exceeds number/frequency approved /allowed within time period without support documentation.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["BHUL","NON-CONTRACTED CODE","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["BP","CODE IS A BILATERAL PROCEDURE CODE, REIMBURSEMENT  BASED ON  BOTH SIDES BEING PERFORMED, CANNOT BE BILLED AS BILATERAL.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["BLT","PROCEDURE IS NOT VALID WHEN BILLED ON HCFA FORM OR WITH THE TYPE OF BILL CODE USED.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IBPR","Bilateral payment adjustment has been applied to the claim.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IBPS","PLACE OF SERVICE MISSING OR INVALID.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IBSP","Procedure Code is not typically performed by a physician at the billed Place of Service.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PTYM","PRE-AUTHORIZATION REQUIRED AFTER 12 VISITS","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["P6YM","PRE-AUTHORIZATION REQUIRED AFTER 6 VISITS","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["OS2","PREAUTHORIZATION REQUIRED FOR OUT OF NETWORK SERVICES.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["OBU3","Prior authorization is required after three services within episode of care.","N761","This provider is not authorized to receive payment for the service(s).","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["ORTH","ORTHOTICS REVIEW. PA REQUIRED IF TOTAL CLAIM IS GREATER THAN $250.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["MS2","PRE - AUTHORIZATION REQUIRED FOR MLTSS PLAN.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["OBPM","PRIOR AUTH IS REQUIRED AFTER 3 SERVICES WITHIN EPISODE OF CARE.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["ABDM","PRE - AUTHORIZATION REQUIRED.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["D300","DME OVER $300.00 REQUIRE PREAUTHORIZATION","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["D400","DME OVER $400.00 REQUIRE PREAUTHORIZATION","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["DME5","DME/PROSTHETICS REVIEW. PA REQUIRED IF TOTAL CLAIM > $500","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["HHDM","HOME HEALTH SERVICES REQUIRE PRIOR AUTH AFTER 32 UNITS HAVE BEEN EXCEEDED.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["HFSA","HFS PRIOR AUTHORIZATION REQUIRED","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["HH32","HOME HEALTH SERVICES REQUIRE AUTHORIZATION AFTER 32 UNITS OF SERVICE.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["GS2","PREAUTHORIZATION REQUIRED FOR G0482 OR G0483. NO EXCEPTIONS OR OFFSET ALLOWED UNLESS AUTH IS ON FILE.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["AMAU","EMERGENCY TRANSFERS MUST BE BILLED WITH APPROPRIATE MODIFIER.  NON-EMERGENCY TRANSFERS REQUIRE AUTHORIZATION.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CHYM","PRE - AUTHORIZATION REQUIRED AFTER 10 VISITS","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["20LM","UNITS EXCEEDING 200 UNITS REQUIRES PA PER MEMBER PER PROVIDER","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["20UY","PRIOR AUTHORIZATION REQUIRED FOR SERVICES EXCEEDING 200 UNITS PER YEAR.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["21UM","PRIOR AUTHORIZATION REQUIRED FOR SERVICES EXCEEDING 21 UNITS PER MONTH.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["800U","SERVICES EXCEEDING 800 UNITS PER MEMBER/PER PROVIDER REQUIRE PRE-AUTHORIZATION.","","","OA","OA Other adjustments","197","Precertification/authorization/notification/pre-treatment absent."]
["4U","SERVICES EXCEEDING 4 UNITS PER DAY REQUIRE PRE-AUTHORIZATION.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["4UDM","PRIOR AUTHORIZATION REQUIRED FOR SERVICES EXCEEDING 4 UNITS PER DAY.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["2HLM","PRIOR AUTH IS REQUIRED AFTER UNITS EXCEED 200 UNITS PER MEMBER PER PROVIDER","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["200U","SERVICES EXCEEDING 200 UNITS PER MEMBER/PER PROVIDER REQUIRE AUTHORIZATION","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["80LM","SERVICES EXCEEDING 800 UNITS PER MEMBER PER PROVIDER REQUIRE PRE AUTH.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["7UDA","PRIOR AUTHORIZATION REQUIRED FOR SERVICES EXCEEDING 7 UNITS PER DAY.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["7UDM","PRIOR AUTHORIZATION REQUIRED FOR SERVICES EXCEEDING 7 UNITS PER DAY.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["S2","PRE - AUTHORIZATION REQUIRED.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["S2N","NOTIFICATION I IS REQUIRED FOR THIS SERVICE.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["WC3Y","SERVICES EXCEEDING 3 VISITS PER YEAR REQUIRE AUTHORIZATION","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["WCYM","PRIOR AUTH REQUIRED WHEN SERVICES EXCEEDS 3 VISITS PER YEAR.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["SOBN","PREAUTHORIZATON/NOTIFICATON REQUIRED - OBSERVATION STAY","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["SIPN","PREAUTHORIZATION - NOTIFICATION REQUIRED - INPATIENT STAY","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["PRAU","PRE-AUTHORIZATION REQUIRED FOR PROSTHETICS $500.00 BILLED CHARGES OR MORE","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["SDS2","PRE - AUTHORIZATION REQUIRED FOR SYNAGIS DOSING","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["ORAU","PRE-AUTHORIZATION REQUIRED FOR ORTHOTICS BILLED CHARGES $250.00 OR MORE","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["TOB","TYPE OF BILL INVALID OR MISSING WITH REV CODES BILLED","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ07","Services are not payable when billed by LPHA provider.","N448","This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP12","DRG and/or diagnosis cannot be billed under the registered children''s hospital NPI.","","","CO","Contractual Obligations","12","The diagnosis is inconsistent with the provider type. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP13","HCPCs T2042 and T2045 are not payable in the Hospice setting.","","","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ICAG","PROCEDURE IS INCONSISTENT WITH THE PATIENT''S AGE.","","","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ICCA","The condition code on the claim is invalid.","M44","Missing/incomplete/invalid condition code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ICCP","PROCEDURE IS A COMPONENT OF A COMPREHENSIVE PROCEDURE AND SHOULD BE DENIED.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","B10","Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test."]
["ICDL","PROCEDURE CODE HAS BEEN DELETED.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["CHIR","MAXIMUM FREQUENCY REACHED FOR CHIRO SERVICES. PREAUTH REQUIRED","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["CON","Stop any PAYING out of network COVID Lab/testing claims.","","","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["CCNC","CUSTODIAL CARE NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["CNIF","CLAIM DENIED PER OUTSTANDING REQUEST FOR FURTHER INFORMATION.  PLEASE CONTACT OUR PROVIDER RELATIONS DEPARTMENT AT 207-402-3347.","M25","The 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 an 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.","CO","Contractual Obligations","26","Expenses incurred prior to coverage."]
["CCMO","CORRECTED CLAIM RECEIVED, EXACT DUPLICATE","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["ICON","CONDITION CODE MISSING/INVALID/OR REQUIRES REVIEW.","M44","Missing/incomplete/invalid condition code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ICOS","Procedure is typically considered cosmetic. Please submit claim documentation.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["ICPD","THE CP CODE BILLED IS DUPLICATIVE OF THE E & M CODE BILLED IN THE PATIENT'S HISTORY.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["CPRH","THIS CODE IS PENDING UNTIL RATES ARE PUBLISHED FROM HFS. CLAIMS WILL BE REPROCESSED WHEN THE RATE IS ESTABLISHED.  NO FURTHER ACTION IS REQUIRED ONTHE PROVIDER PART.  THE CLIENT CANNOT BE BILLED FOR THESE SERVICES.","","","OA","OA Other adjustments","133","The disposition of this service line is pending further review. (Use only with Group Code OA). Usage: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837)."]
["ICPT","PROCEDURE CODE IS INVALID, MISSING OR DISABLED.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NCPV","SERVICES DO NOT MEET THE GENDER/AGE/DIAGNOSIS REQUIREMENTS FOR THE PREVENTIVE SERVICES BENEFIT.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CR","CODE IS A COMPOUND PROCEDURE, PAYMENT INCLUDED WITH COMPREHENSIVE PROCEDURE CODE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["OERD","DIALYSIS REVENUE CODE SHOULD BE DENY WITH ER OR OBSERVATION SERVICES FOR MORE THAN 48 HOURS.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CSEX","SERVICES ARE LIMITED TO FOUR PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["ICSX","PROCEDURE INCONSISTENT WITH PATIENT''S GENDER.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["HCUB","SERVICES BILLED WITH APL CODE.  SERVICES MUST BE BILLED ON UB CLAIM FORM.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["CVD","SUBMITTED PROCEDURE CODE BILLED FOR SAME DATE OF SERVICE WITH OTHER PROVIDER TIN","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["TD01","THE BILLED SERVICE OR SUPPLY IS NOT SUPPORTED BY THE SUBMITTED DOCUMENTATION.","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["D21","THIS (THESE) DIAGNOSIS(ES) IS (ARE) MISSING OR ARE INVALID.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["D60","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 60 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D90","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 90 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["IDAC","Age conflict; patient's age and diagnosis code are inconsistent.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDAG","PATIENT'S AGE AND GENDER ARE INCONSISTENT WITH DIAGNOSIS.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DASA","INCORRECT BILLING RULES- DASA PROVIDER","","","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["DBM","SERVICE IS LIMITED TO ONE VISION EXAM PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IDCM","ICD-9 TO ICD-10 DIAGNOSIS COMPARISON","","","CO","Contractual Obligations","20","This injury/illness is covered by the liability carrier."]
["IDDA","Patient's age and a diagnosis on this claim are incompatible.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDDB","Patient's gender and a diagnosis on this claim are incompatible.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDDC","Patient's age and gender are incompatible with the patient's admission diagnosis.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDDP","The Diagnosis code is a duplicate of the Principal Diagnosis.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDDS","The submitted Diagnosis code is a duplicate of another secondary diagnosis code on this claim.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DFEX","SERVICES ARE LIMITED TO ONE PAIR A YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IDI2","The diagnosis code is invalid; there is an unnecessary 4th/5th digit.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDI3","The diagnosis code is invalid; there is a missing 4th/5th digit.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDI4","The diagnosis code is invalid; the code was found on the ICD-9-CM table, but not valid for the patient's admission/discharge date.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDI5","The diagnosis code is invalid; there is an unnecessary 4th/5th digit for the patient's admission/discharge date.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDI6","The diagnosis code is invalid; there is a missing 4th/5th digit for the patient's admission/discharge date.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["DIAG","CLAIM WAS SUBMITTED WITH AN INVALID OR MISSING DIAGNOSIS CODE.  THIS CLAIM CANNOT BE PROCESSED UNTIL A CORRECT CLAIM HAS BEEN RECEIVED.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDIS","The Patient Gender is invalid.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DMAU","DME OVER $500.00 REQUIRE PRE-AUTHORIZATION.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["DMEK","PREAUTH REQUIRED FOR DME GREATER THAN $1,000.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["EDMR","MEDICAL RECORDS REQUIRED.","M127","Missing patient medical record for this service.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["IDOB","MISSING OR INVALID DATE OF BIRTH","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDP1","The procedure code is invalid, the code is not found on the table of valid ICD-9-CM codes.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDP2","Principal Diagnosis Invalid - Manifestation code cannot be used as principal diagnosis.","MA66","Missing/incomplete/invalid principal procedure code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDP3","Principal Diagnosis Invalid - Non-specific code cannot be used as principal diagnosis.","MA66","Missing/incomplete/invalid principal procedure code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDP4","Principal Diagnosis Invalid - Principal diagnosis indicates questionable admission.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDP5","Principal Diagnosis Invalid - Unacceptable principal diagnosis","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDP6","Principal Diagnosis Invalid - Unacceptable principal diagnosis without required secondary diagnosis.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDPC","MISSING PROCEDURE CODE FOR DEVICE BILLED.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDPD","Principal Diagnosis Invalid - 'E' Code cannot be used as principal diagnosis","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["EDRG","Claim has been flagged for medical record review by Optum. Please follow documentation instructions on the Optum Medical Record Request letter.  Alternatively, the documentation can be emailed to recordsintake@optum.com OR Faxed to 646-349-2406. For additional information, please contact Optum at 877-787-2310.","M127","Missing patient medical record for this service.","CO","Contractual Obligations","B12","Services not documented in patient's medical records."]
["DRVE","ITEM SHOULD BE PURCHASED THROUGH PHARMACY VENDOR","N418","Misrouted claim.  See the payer's claim submission instructions.","OA","OA Other adjustments","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["IDSC","Patient's age and gender are inconsistent with the patient's diagnosis code.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDTU","DISCREPANCY BETWEEN UNITS AND FROM AND THROUGH DATES.","N345","Date range not valid with units submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDUP","CLAIM HAS BEEN IDENTIFIED AS A DUPLICATE CLAIM IN PATIENT''S HISTORY.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["IDXM","INVALID DIAGNOSIS. MISSING NECESSARY ADDITIONAL DIGITS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DXNC","THIS SERVICE IS NOT ELIGIBLE FOR THE DIAGNOSIS BILLED.","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IDXU","INVALID DIAGNOSIS. INCLUDES UNNECESSARY ADDITIONAL DIGITS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["EAMD","SERVICE NOT BILLED WITH APPROPRIATE MODIFIER.","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EED","Early Elective Delivery - Services are not covered under IHCP Hoosier Healthwise and Healthy Indiana Plan.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["IEMO","VISIT CANNOT BE BILLED SAME DAY AS PROCEDURE","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["VENC","VENT CARE NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["EO","PLEASE SUBMIT COPY OF PRIMARY INSURANCE EXPLANATION OF PAYMENT.","N479","Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["IEPD","E-CODES NOT ALLOWED AS PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IERB","INVALID EMERGENCY ROOM BILLING REV/HCPC COMBINATION PER HFS APL GUIDELINES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["EST1","ELECTIVE STERILIZATION FOR MEMBERS AGE 21 AND OLDER REQUIRES A CONSENT FORM.  SERVICES DO NOT REQUIRE AUTHORIZATION.","N398","Missing elective consent form.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["ZPCP","PCP REJECT PC01 TESTING","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["EFIN","Claim denied due to Optum pre-pay DRG review. Please see documentation from Optum for more information. For questions call: 877-787-2310.","N208","Missing/incomplete/invalid DRG code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IFMS","TRAINING AND EDUCATION MUST BE BILLED WITH OTHER SERVICES.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["JFPI","REFUND RECEIVED DUE TO A PREVIOUSLY PAID INTEREST","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["MT12","SERVICES ARE LIMITED TO 12 MANIPULATION THERAPY VISITS PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["MGYM","SERVICES ARE LIMITED TO ONE BASELINE MAMMOGRAM FOR AGES 35 AND OVER; OR ONE SCREENING PER YEAR FOR AGES 40 AND OVER.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["MATF","MEDICATION ASSISTED TREATMENT FREQUENCY EXCEEDED. PER HFS ONLY 1 UNIT IS ALLOWED PER 7 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["MAML","SERVICES ARE LIMITED TO ONE BASELINE MAMMOGRAM FOR AGES 35 AND OVER; OR ONE SCREENING PER YEAR FOR AGES 40 AND OVER.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["90DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 90 EVERY 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D115","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 15 MONTHS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D120","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 120 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D12R","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO 12 PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D12Y","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 2 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D13Y","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 3 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D14M","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 4 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["CCMM","CRITICAL CARE IS LIMITED TO 10 VISITS PER CONFINEMENT.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D66M","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO SIX EVERY 6 MONTHS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D22Y","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 2 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D1PY","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE PER YEAR.","M90","Not covered more than once in a 12 month period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D1YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D1DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D190","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO 190 PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D15Y","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 5 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D16M","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D180","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 180 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D46M","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO FOUR EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D4DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 4 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D4PY","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO FOUR PER YEAR.","N414","This service is allowed 4 times in a 12-month period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D4YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO FOUR PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D50","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 50 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D36M","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO THREE EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D3DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 180 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D3PY","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO THREE PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D3YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO THREE PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D23Y","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 3 YEARS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["D25M","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 5 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D26M","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D2DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D2P1","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D2PY","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO PER YEAR.","N412","This service is allowed 2 times in a 12-month period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D2YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D30","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 30 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DVMM","SERVICE IS LIMITED TO 3 TIMES WITHIN A 12 MONTH PERIOD FOR MEMBER AGE BETWEEN 0-20.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DME6","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 6 EVERY 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DME8","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 8 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DME1","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DME2","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DME3","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 3 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DME4","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 4 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["DM50","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 50 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM2","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM20","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 20 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["8DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 8 EVERY 90 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["CC20","CRITICAL CARE IS LIMITED TO 20 VISITS PER CONFINEMENT.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM10","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 10 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM12","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 12 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["DM02","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 180 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["D10","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 10 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["CR36","CARDIAC REHAB SERVICES ARE LIMITED TO 36 VISITS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["16MM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["15YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 5 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["16DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 10 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["20DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 20 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["22YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 2 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["20VS","SERVICE IS LIMITED TO 20 VISITS.","N640","Exceeds number/frequency approved/allowed within time period.","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["3MM","SERVICE IS LIMITED TO 3 TIMES WITHIN A 6 MONTH PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["3P12","SERVICE IS LIMITED TO 3 TIMES WITHIN A 12 MONTH PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["3P6","SERVICE IS LIMITED TO 3 TIMES WITHIN A 6 MONTH PERIOD.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["3DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 3 EVERY 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["23YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 3 YEARS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["23DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["60DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 60 EVERY 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["15DM","SERVICE EXCEEDS QUANTITY LIMITATIONS. T4541 IS LIMITED TO 150 EVERY 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["14MM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 4 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["14RH","SERVICES ARE LIMITED TO 14 DAYS OF INPATIENT RESPITE CARE ANNUALLY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["39DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 3 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["2TDM","SERVICE EXCEEDS QUANTITY LIMITATIONS.  INCONTINENCE SUPPLIES ARE LIMITED TO 200 EVERY 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["2YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 2 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["300L","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 300 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["83DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 8 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["6DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 6 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["66MM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO SIX EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["02DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 180 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["99DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 9 EVERY 90 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["1SMM","BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["1TDM","SERVICE EXCEEDS QUANTITY LIMITATIONS. T4535 IS LIMITED TO 120 EVERY 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["26MM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["1PYM","SERVICES LIMITED TO ONCE PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["1PYR","SERVICES LIMITED TO ONCE PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["1PLM","SERVICES ARE LIMITED TO ONE NEW PATIENT VISIT PER LIFETIME.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["1P6M","SERVICES ARE LIMITED TO ONE EVERY 6 MONTHS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["1P24","SERVICE IS LIMITED TO ONE PER 24 MONTHS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["1HDM","DME SERVICE EXCEEDS QUANTITIY LIMITS. SVC LIMITED TO 100 PER 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["25MM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO TWO EVERY 5 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["30DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 30 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["1DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["19YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO 190 PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["13YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO ONE EVERY 3 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["12YM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO 12 PER YEAR.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["10MD","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 10 EVERY 10 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["10DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 10 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["19DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 1 EVERY 90 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["18DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 18 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["13DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 120 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["12DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 12 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["63DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 6 EVERY 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["50DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 50 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["4DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 4 EVERY 60 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["33DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 300 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["2DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 2 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["2HDM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 200 EVERY 30 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["RFCL","ROUTINE FOOT CARE IS LIMITED TO ONCE VERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["RFDM","ROUTINE FOOT CARE IS LIMITED TO ONCE EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["V6DM","SERVICE EXCEEDS QUANTITY LIMITATIONS-- V5266 IS LIMITED TO 16 UNITS EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["PODI","INITIAL VISIT ONLY COVERED ONCE PER PATIENT PER PROVIDER OR PROVIDER GROUP","N113","Only one initial visit is covered per physician, group practice or provider.","CO","Contractual Obligations","B1","Non-covered visits."]
["SEQL","SERVICE EXCEEDS QUANTITY LIMITATIONS-- V5266 IS LIMITED TO 16 UNITS EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["SN90","SKILLED NURSING FACILITY LIMITED TO 90 DAYS PER CALENDER YEAR","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NCMM","CRITICAL CARE IS LIMITED TO 20 VISITS PER CONFINEMENT.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PDLM","INITIAL VISIT ONLY COVERED ONCE PER PATIENT PER PROVIDER OR PROVIDER GROUP","N113","Only one initial visit is covered per physician, group practice or provider.","CO","Contractual Obligations","B1","Non-covered visits."]
["TH4","THERAPY SERVICE LIMITED TO FOUR UNITS PER DAY","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["TH1","THERAPY SERVICE LIMITED TO ONE UNIT PER DAY","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["TH8","THERAPY SERVICE LIMITED TO EIGHT UNITS PER DAY","N362","The number of Days or Units of Service exceeds our acceptable maximum.","OA","OA Other adjustments","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["T1DD","PRIOR AUTHORIZATION REQUIRED FOR T1015 EXCEEDING 1 VISIT PER 15 DAY.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["SCL","SMOKING CESSATION LIMIT HAS BEEN EXCEEDED FOR THIS SERVICE","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["SCYM","SMOKING CESSATION LIMIT HAS BEEN EXCEEDED FOR THIS SERVICE","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["36MM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO THREE EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["36DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 3 EVERY 60 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["46MM","DME SERVICE EXCEEDS QUANTITY LIMITATIONS. SERVICE LIMITED TO FOUR EVERY 6 MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["53DM","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 15 PER 30 DAYS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IFTD","INVALID FROM AND/OR THROUGH DATES OR ADMISSION DATE.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["FUD","E&M CODE INCLUDED IN GLOBAL RATE. PATIENT IS NOT RESPONSIBLE FOR BALANCE.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["FV","OFFICE VISIT WITHIN GLOBAL SURGICAL PERIOD, NO ADDITIONAL PAYMENT DUE.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IGFP","Procedure Code is within the global period of  History Procedure Code performed by the same provider.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["GNS2","PRE-AUTHORIZATION REQUIRED FOR GENETIC TESTING, NO EXCEPTION OR OFFSET ALLOWED UNLESS AUTH IS ON FILE","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["GO","GLOBAL TO OTHER PROCEDURE(S) BILLED FOR THE SAME DATE OF SERVICE, PATIENT IS NOT RESPONSIBLE.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IGSP","PROCEDURE BILLED WITHIN GLOBAL PERIOD OF MAJOR PROCEDURE PERFORMED.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IHAC","DIAGNOSIS INDICATES HOSPITAL ACQUIRED CONDITION WHICH IS NOT COVERED.","","","CO","Contractual Obligations","167","This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IHCC","The submitted procedure code is a component of a previously submitted code and should be denied.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IHME","The billed procedure code is considered Mutually Exclusive to a claim in the patient's history and should be denied.","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["HHNC","PROVIDER TYPE 057 IS NOT REGISTERED FOR HOME HEALTH CODES","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["HSPE","PAYMENT IS MADE FOR ONLY ONE CATEGORY OF HOSPICE CARE ON A PARTICULAR DAY.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["I10","PLACE OF SERVICE MAY BE INAPPROPRIATE FOR TREATMENT.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["I14","PROCEDURE IDENTIFIED AS EXCLUSIVE WITH ANOTHER PROCEDURE.  PATIENT IS NOT RESPONSIBLE FOR BALANCE.","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["I15","PROCEDURE IDENTIFIED AS INCIDENTAL TO ANOTHER PROCEDURE.  PATIENT IS NOT RESPONSIBLE FOR BALANCE.","N19","Procedure code incidental to primary procedure.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["I16","CPT/HCPC CODE IS UNLISTED.  PLEASE RESUBMIT WITH VALID CODE.  PLEASE INCLUDE COPY OF INVOICE IF APPLICABLE.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","189","Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service"]
["I5","CPT TO ANESTHESIA CROSSWALK CANNOT BE DETERMINED WITHOUT DOCUMENTATION.  PLEASE RESUBMIT.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["I7","PROCEDURE IS TYPICALLY ELECTIVE IN NATURE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["IAD","INVALID ADMIT DIAGNOSIS.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IIAG","DIAGNOSIS INCONSISTENT WITH PATIENT AGE.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IAMB","A0425 DENIED IF BILLED WITHOUT A0428 OR A0429","","","CO","Contractual Obligations","B15","This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IANE","PROCEDURE BILLED BY A PROVIDER NOT LISTED AS ANESTHESIA PROVIDER.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IAO","PROCEDURE IS AN ADD-ON CODE AND MUST BE BILLED WITH THE PRIMARY PROCEDURE.","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["AO","PROCEDURE IS AN ADD-ON CODE AND MUST BE BILLED WITH THE PRIMARY PROCEDURE.","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","107","The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IIBM","MODIFIER FB OR FC IS INVALID.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IIBP","PROCEDURE IS BILATERAL AND SHOULD NOT BE BILLED MORE THAN ONCE PER DATE OF SERVICE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["EIBR","Claim has been flagged for itemized bill review by Optum. For additional information, please contact Optum at 800-304-5649.","N26","Missing itemized bill/statement.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["ICA","CA MODIFIER REQUIRES PATIENT STATUS CODE 20.","MA43","Missing/incomplete/invalid patient status.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IICD","The diagnosis billed is invalid or disabled.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDID","The diagnosis code is invalid; the code is not found on the table of valid ICD-10-CM codes.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IICM","The Principal DX is missing or invalid.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["ICM","DIAGNOSIS MISSING, INVALID, OR TOO NON-SPECIFIC","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IICR","SURGICAL CODE REQUIRES CROSSWALK TO ANESTHESIA CODE.","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NICU","NICU Inpatient claims review required for Authorization.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["IDAS","Patient's gender and diagnosis code are inconsistent.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDD","DUPLICATE DIAGNOSIS ON SAME CLAM.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IDIA","Age invalid; not in range 0-124 years.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IIDX","Dx billed is a nonspecific diagnosis code and requires a fourth and/or fifth digit.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["IDX","INVALID DX.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IIMD","DIAGNOSIS AND MODIFIER COMBINATION INAPPROPRIATE.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["IIMO","INVALID MODIFIER.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["IMP","50% REDUCTION OF ALLOWED AMOUNT APPLIED TO LINE.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["INCS","NOT A COVERED SERVICE UNDER THE PLAN BENEFITS.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IINV","This Procedure Code is considered investigational or experimental.  Please submit documentation.","N623","Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.","CO","Contractual Obligations","55","Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IIPC","INVALID PROCEDURE CODE.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["IPC","INVALID PROCEDURE CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPD","INVALID PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IIRC","MISSING OR INVALID REVENUE CODE.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IRRH","REVENUE CODE ALSO REQUIRES HCPCS CODE.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ISL","THE PROVIDER ADDRESS BILLED IS NOT A VALID SERVICE LOCATION.  PLEASE RESUBMIT WITH ACTUAL SERVICE ADDRESS.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IISX","DIAGNOSIS INCONSISTENT WITH PATIENT GENDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ITRC","TRAUMA REVENUE AND PROCEDURE CODES REQUIRED FOR CRITICAL CARE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IUB","PROCEDURE HAS UNBUNDLE RELATIONSHIP WITH ANOTHER PROCEDURE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["LOA","PAID IN ACCORANCE WITH LETTER OF AGREEMENT.","","","CO","Contractual Obligations","131","Claim specific negotiated discount."]
["ILOS","PROCEDURE PERFORMED IS INCONSISTENT WITH THE LENGTH OF STAY.","","","CO","Contractual Obligations","152","Payer deems the information submitted does not support this length of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ILPC","CLAIM LACKS REQUIRED PRIMARY CODE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["M26","THE PROCEDURE CODE IS MISSING A REQUIRED MODIFIER.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IM26","Procedure Code billed requires a modifier -26 when billing for the professional component in this place of service.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IM54","USE OF MODIFIER 54 INDICATES INTRAOPERATIVE PORTION OF THE GLOBAL ONLY.","","","CO","Contractual Obligations","B20","Procedure/service was partially or fully furnished by another provider."]
["IM55","USE OF MODIFIER 55 INDICATES POSTOPERATIVE PORTION OF THE GLOBAL ONLY.","","","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["IM56","USE OF MODIFIER 56 INDICATES PREOPERATIVE PORTION OF THE GLOBAL ONLY.","","","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["IM76","REPEAT NONCLINICAL LAB PROCEDURES MUST BE BILLED WITH MODIFIER 76.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IM78","USE OF MODIFIER 78 INDICATES INTRAOPERATIVE PORTION OF THE GLOBAL ONLY.","","","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["DM8","DME SERVICE EXCEEDS QUANTITY LIMITS. SVC LIMITED TO 8 EVERY 90 DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["IM91","REPEAT DIAGNOSTIC TESTS MUST BE BILLED WITH MODIFIER 91","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMAN","Anesthesia code on this line requires an appropriate modifier.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMBP","BILATERAL PROCEDURE PAYMENT REDUCTION APPLIED.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMCO","CO-SURGEONS ARE NOT PERMITTED FOR THIS PROCEDURE.","N646","Reimbursement has been adjusted based on the guidelines for an assistant.","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMD1","PROCEDURE REQUIRES A REVIEW OF THE MEDICAL NECESSITY OF A SURGICAL ASSISTANT.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMD2","PROCEDURE REQUIRES A REVIEW OF THE MEDICAL NECESSITY OF TWO SURGEONS.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMD3","PROCEDURE REQUIRES A REVIEW OF THE MEDICAL NECESSITY OF A SURGICAL TEAM.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMDH","This procedure code and a procedure code in patient's history indicate that multiple imaging services were performed. Per CMS, a reduction of the technical component applies for this line.","","","CO","Contractual Obligations","134","Technical fees removed from charges."]
["IMDT","Per the Medicare Physician Fee Schedule, the submitted Procedure Code describes a diagnostic procedure that requires a professional component modifier for this place of service type.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MDX","SERVICES ONLY PAYABLE WITH APPROPRIATE MODIFIER(S) AND/OR DIAGNOSIS.","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMD","PROCEDURE REQUIRES REVIEW FOR MEDICAL NECESSITY OF ADDITIONAL PROVIDERS.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMEO","PROCEDURE IS MUTALLY EXCLUSIVE TO ANOTHER PROCEDURE EITHER ON THIS CLAIM OR A CLAIM IN HISTORY.","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["MEY","ALL LINES MUST CONTAIN EY MODIFIER.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMFD","MAXIMUM DAILY FREQUENCY FOR PROCEDURE EXCEEDED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["IMFH","The maximum frequency for this procedure has been exceeded between this claim and the same procedure in the patient's history.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMFP","Charges are within the Global Follow up days of the procedure performed.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMFX","MAXIMUM FREQUENCY FOR PROCEDURE EXCEEDED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["IMGT","Per the Medicare Physician Fee Schedule the procedure code describes the global code of a service or diagnostic test. The submitted modifier is not appropriate.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMIC","MODIFIER YZ IS NOT APPROPRIATE FOR THIS SERVCE","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MLTS","SERVICE NOT COVERED UNDER MLTSS PLAN AND/OR BY PROVIDER RENDERING SERVICES.","N216","We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMMV","MULTIPLE VISITS CANNOT BE BILLED ON THE SAME DAY FOR THE SAME REVENUE CODE","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["MNC","SERVICES NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["IIMC","MODIFIERS BILLED CANNOT BE USED ON SAME LINE.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MOR","PROPER MODIFIER IS REQUIRED IN ORDER TO CONSIDER PROCEDURE FOR BENEFITS.","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMP5","OPERATIVE REPORT REQUIRED WHEN MORE THAN 5 PROCEDURES ARE PERFORMED ON SAME DATE OF SERVICE","M29","Missing operative note/report.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["IMPC","MODIFIER XY IS NOT APPROPRIATE FOR THIS SERVICE.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMPI","PHYSICIAN INTERPRETATION SERVICE NOT PAYABLE IN PLACE OF SERVICE BILLED.","","","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IMPT","PHYSICAL THERAPY SERVICE NOT PAYABLE IN PLACE OF SERVICE BILLED.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["MSO","OTHER MSO LIABILITY","","","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["IMTC","MODIFIER BILLED IS INAPPROPRIATE AS THE PROCEDURE BILLED IS ONLY THE TECHNICAL PORTION OF THIS SERVICE.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IMTS","TEAM SURGERY IS NOT PERMITTED FOR THIS PROCEDURE.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ADMX","ACCIDENTAL DENTAL BENEFITS ARE LIMTIED TO $3000.00.","N587","Policy benefits have been exhausted.","CO","Contractual Obligations","P6","Based on entitlement to benefits. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only."]
["NC","INVALID OR MISSING CPT4 OR HCPCS PROCEDURE CODE.  THIS CLAIM CANNOT BE PROCESSED UNTIL A CORRECT CLAIM HAS BEEN RECEIVED.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INCD","PROCEDURE IDENTIFIED AS INCIDENTAL TO ANOTHER PROCEDURE. PATIENT IS NOT RESPONSIBLE FOR BALANCE.","N19","Procedure code incidental to primary procedure.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["INCE","Non-covered based on statutory exclusion.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NCHA","NEW CENTURY HEALTH AUTHORIZATION REQUIRED.","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["NCMP","SERVICES NOT COVERED BY BENEFIT PLAN","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["NCN","RENDERING PROVIDER IS NOT ELIGIBLE TO PERFORM THE BILLED SERVICE.","N95","This provider type/provider specialty may not bill this service.","OA","OA Other adjustments","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NCS","SERVICES NOT COVERED BY BENEFIT PLAN","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["NCTX","SERVICES BY THIS PROVIDER TYPE ARE NOT COVERED UNDER THE PLAN.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["NDC","NDC NUMBER IS REQUIRED.  THIS CLAIM CANNOT BE PROCESSED UNTIL A CORRECT CLAIM HAS BEEN RECEIVED.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["RNDC","NDC NUMBER IS REQUIRED.  THIS CLAIM CANNOT BE PROCESSED UNTIL A CORRECT CLAIM HAS BEEN RECEIVED.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NDCX","HCPCS MUST BE BILLED WITH A VALID NDC NUMBER.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INFO","THIS IS A NON-REIMBURSABLE INFORMATIONAL CODE ONLY","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INPD","DIAGNOSIS NOT TO BE LISTED AS THE PRIMARY.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["1NPL","SERVICES ARE LIMITED TO ONE NEW PATIENT VISIT PER LIFETIME.","N117","This service is paid only once in a patient's lifetime.","CO","Contractual Obligations","149","Lifetime benefit maximum has been reached for this service/benefit category."]
["INPT","NEW PATIENT VISIT BILLED FOR AN ESTABLISHED PATIENT; REBILL CORRECT CODE.","m51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["INRS","HCPCS CODE BILLED IS NOT PAYABLE FOR TYPE OF BILL","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IOAP","OBSERVATION HCPCS CODE MISSING FROM CLAIM PER HFS GUIDELINES.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["NOCD","OON COVID TESTING NOT COVERED.","N431","Not covered with this procedure.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IOID","INVALID OTHER DIAGNOSES.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IOIS","ONLY INCIDENTAL SERVICES WERE BILLED ON THIS CLAIM. THESE SERVICES ARE TO BE PAID AS PART OF ANOTHER PRIMARY SERVICE.","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["OMID","MISSING OR INVALID MEDICAID ID FOR ORDERING PROVIDER BILLED","","","CO","Contractual Obligations","256","Service not payable per managed care contract."]
["OPNF","Ordering Provider Not Found","N265","Missing/incomplete/invalid ordering provider primary identifier.","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["IORP","ALERT (ORP): Entity's National Provider Identifier (NPI). Missing or invalid information.","","","OA","OA Other adjustments","206","National Provider Identifier - missing."]
["IOSR","PRIMARY SURGICAL PROCEDURE TYPICALLY PERFORMED IN AN OFFICE SETTING.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["P03","PROVIDER NOT ENROLLED FOR CATEGORY OF SERVICE OR DATE OF SERVICE. IF THERE IS A DISCREPANCY, PLEASE CONTACT THE PROVIDER PARTICIPATION UNIT: https://www.illinois.gov/hfs/impact/Pages/ProviderEnrollment.aspx","M143","The provider must update license information with the payer.","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP27","REV code is not reimbursable when billed without corresponding CPT/HCPCS code.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP29","COVID procedure code is only valid for certain age patients","","","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP34","Primary diagnosis is not typical for patient's age.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PANC","PATIENT IS OUTSIDE THE AGE LIMITATIONS FOR THIS PROCEDURE.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPAT","PATIENT ID MISSING.","N382","Missing/incomplete/invalid patient identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPCD","CODE NOT WITHIN APPROVAL DATE.","N175","Missing review organization approval.","CO","Contractual Obligations","251","The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["IPCM","MODIFIER -26 IS NOT APPROPRIATE FOR THIS PROCEDURE BECAUSE THE PROCEDURE IS DEFINED AS 100% PROFESSIONAL OR 100% TECHNICAL.","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPDE","E CODES ARE NOT ALLOWED AS PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPDI","DIAGNOSTIC INTERVIEW WILL BE DENIED AS PART OF CONSULTATION WHEN BILLED WITHIN 30 OF THAT CONSULT BY SAME PROVIDER.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IPDM","MANIFESTATION CODES NOT ALLOWED AS PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPDQ","PRINCIPAL DIAGNOSIS IS FOR QUESTIONABLE ADMISSION.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPDS","PRINCIPAL DIAGNOSIS REQUIRES SECONDARY DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPDU","INVALID PROCEDURE CODE. INCLUDES UNNECESSARY ADDITIONAL DIGIT.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PNEP","PROVIDER NOT ELIGIBLE FOR PAYMENT","N238","Incomplete/invalid physician certified plan of care.","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["POD","PODIATRIC SERVICES REQUIRE PA AFTER 6 VISITS","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["IPOS","INVALID PLACE OF SERVICE SUBMITTED.  SERVICES MUST BE SUBMITTED WITH A VALID TWO DIGIT CODE.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["P1MM","THIS SERVICE IS LIMITED TO TWO POSTPARTUM VISIT PER PREGNANCY.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["PP1","THIS SERVICE IS LIMITED TO ONE POSTPARTUM VISIT PER PREGNANCY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["PPT","THIS PROCEDURE IS ONLY PAYABLE ONCE PER PREGNANCY.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["PPDM","THIS PROCEDURE IS ONLY PAYABLE ONCE PER PREGNANCY.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["PPVF","TWO PNEUMOCOCCAL PNEUMONIA VACCINES BILLED IN ONE YEAR - CLAIM MUST HAVE CORRECT DX CODES BILLED TO RECEIVE MORE THAN ONE VACCINE PER YEAR","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PVYM","TWO PNEUMOCOCCAL PNEUMONIA VACCINES BILLED IN ONE YEAR - CLAIM MUST HAVE CORRECT DX CODES BILLED TO RECEIVE MORE THAN ONE VACCINE PER YEAR","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPRD","REDUCTION FOR ASSISTANT, CO-, OR TEAM SURGEON.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IPRE","PRE-OP EXAM ONE DAY PRIOR TO PROCEDURE IS PART OF THE GLOBAL SURGICAL PACKAGE AND NOT ALLOWED.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IPRV","MISSING PROVIDER ID.","","","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["PSB","PER HFS PSYCH TYPE B INTENSIVE OUTPATIENT PROGRAM MUST BE BILLED WITH REV CODE 0913, AND PARTIAL HOSPITALIZATION PROGRAM MUST BE BILLED WITH REV CODE 0912.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPSC","PATIENT STATUS CODE MISSING OR INVALID","MA43","Missing/incomplete/invalid patient status.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IPSX","PATIENT GENDER MISSING OR INVALID","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PTS2","THERAPY EXCEEDING 12 VISITS/HOURS PER 30 DAYS REQUIRES PRE-AUTHORIZATION.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["XQ19","COVID-19 procedure M0201 is only payable in the home setting","N428","Not covered when performed in this place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ22","The procedure is not typical for patient age. (Clinics)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ48","CMHC services not billed appropriately","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ50","PROVIDER CATEGORY OF SERVICE IS NOT ALLOWED TO BILL FOR THIS SERVICE","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ54","Units billed exceed those allowed per year based on DSMES fee schedule.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ60","Provider is not allowed to bill for genetic counseling","N808","Not covered for this provider type / provider specialty.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ61","PROVIDER NOT BILLING PER DPP BILLING GUIDELINE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["RT","NON-TIMELY FILED CLAIM, PATIENT NOT RESPONSIBLE.","","","CO","Contractual Obligations","29","The time limit for filing has expired."]
["RCPT","REVENUE CODE BILLED REQUIRES DETAILED CODING WITH HCPCS/CPT4 IN ORDER FOR CLAIM TO BE CONSIDERED FOR REIMBURSEMENT.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["REV","REVENUE CODE BILLED IS INVALID. PLEASE BILL WITH A VALID REVENUE CODE FOR CONSIDERATION.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["RMID","MISSING OR INVALID MEDICAID ID FOR REFERRING PROVIDER BILLED","N276","Missing/incomplete/invalid other payer referring provider identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["RPNC","REPAIR COSTS COVERED BY WARRANTY ARE NOT COVERED.","N171","Payment for repair or replacement is not covered or has exceeded the purchase price.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["RPNF","Referring Provider Not Found","N286","Missing/incomplete/invalid referring provider primary identifier.","CO","Contractual Obligations","206","National Provider Identifier - missing."]
["RTFT","ROUTINE FOOT CARE IS NOT COVERED UNDER THE PLAN.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["ISAM","ONLY ONE SURGICAL ASSISTANT IS ALLOWED FOR THIS PROCEDURE.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ISAS","PROCEDURE TYPICALLY DOES NOT REQUIRE A SURGICAL ASSISTANT.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ISBP","MEDICAID BILATERAL PAYMENT ADJUSTMENT","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["SDC","EXPENSES INCURRED AFTER COVERAGE TERMINATED","","","PR","PR Patient Responsibility","27","Expenses incurred after coverage terminated."]
["SDOP","CLAIM DENIED - SUPPORTING HEALTH RECORD DOCUMENTATION MUST BE SUBMITTED PRIOR TO PAYMENT.","N358","Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["ISDR","MEDICAID DIAGNOSTIC RADIOLOGY REDUCTION","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ISER","MEDICAID MULTIPLE ENDOSCOPY REDUCTION","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ISEX","The patient's gender is invalid or missing.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ISMP","MEDICAID MULTIPLE PROCEDURE REDUCTION","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ISMU","Per Medicaid Medically Unlikely Edits, the units of service billed for this procedure  exceed the allowed number of units.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["ISNA","INPATIENT SEPARATE PROCEDURE NOT PAID.","M2","Not paid separately when the patient is an inpatient.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["SNCA","PRE - AUTHORIZATION - SPECIAL NEEDS CHILDREN PROGRAM","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["SNES","NOT COVERED PER HFS GUIDELINES OR NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT.","N20","Service not payable with other service rendered on the same date.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["SNCO","PRE - AUTHORIZATION REQUIRED FOR OUT OF NETWORK SERVICES - SPECIAL NEEDS CHILDREN PROGRAM","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["ISOA","MISSING/INVALID POINT OF ORIGIN","M25","The 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 an 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.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ISOP","The HCPCS code on this line is billed for a date of service that is not within the specified approval date for this service.","N56","Procedure code billed is not correct/valid for the services billed or the date of service billed.","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["ISPA","HCPCS DATE OF SERVICE NOT WITHIN FDA APPROVAL DATE.","","","CO","Contractual Obligations","188","This product/procedure is only covered when used according to FDA recommendations."]
["ASRD","PRE - AUTHORIZATION REQUIRED","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["SSV","SERVICES SUBMITTED FOR INFORMATIONAL PURPOSES ONLY AND NOT REIMBURSABLE.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ISSP","SERVICE IS NOT PAYABLE WHEN BILLED SEPARATELY","N390","This service/report cannot be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ASST","Assistant surgeon bills outside of the PFS indicating a Y for surg assistant, it's not payable.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ISTR","SURGICAL TRAY NOT BILLABLE FOR THIS PROCEDURE AND THIS PLACE OF SERVICE.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["STS2","SPEECH THERAPY EXCEEDING 12 VISITS/HOURS PER YEAR REQUIRES PRE-AUTHORIZATION.","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["ISUB","Add-on procedure code has been submitted without an appropriate primary procedure code.","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["ISUN","Per Medicaid National Correct Coding Initiative edits, Procedure Code billed has an unbundled relationship with another Procedure Code billed for the same date of service on same claim.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["ITBP","TERMINATED PROCEDURE SHOULD NOT BE BILLED AS BILATERAL.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ITFE","MEDICARE TIMELY FILING","","","CO","Contractual Obligations","29","The time limit for filing has expired."]
["TFMS","THIS CLAIM WAS RECEIVED BEYOND YOUR PLAN''''S TIMELY FILING LIMIT.","","","CO","Contractual Obligations","29","The time limit for filing has expired."]
["STNC","THIS PROCEDURE IS NOT COVERED IN THIS SETTING.","","","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["ITOA","MISSING OR INVALID TYPE OF ADMISSION","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ITOB","TYPE OF BILL CODE IS MISSING OR INVALID FOR PLACE OF SERVICE BILLED.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ITPR","THESE CHARGES ARE PENDING UNTIL WE RECEIVE A POLICE REPORT WITH PROOF OF IDENTITY THEFT.","","","CO","Contractual Obligations","224","Patient identification compromised by identity theft. Identity verification required for processing this and future claims."]
["TRA","CPT/HCPC CODE INAPPROPRIATELY SUBMITTED AND MAY BE REBUNDLED TO A DIFFERENT CODE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["TRC","TRANSPLANT RELATED CLAIM HAS BEEN MISDIRECTED.  PLEASE SUBMIT CLAIM TO OPTUM FOR CONSIDERATION. OPTUM, PO BOX 30758, SALT LAKE CITY, UT 84130 OR USE ELECTRONIC PAYOR ID 41194.","N418","Misrouted claim.  See the payer's claim submission instructions.","CO","Contractual Obligations","109","Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor."]
["TRN","PA REQUIRED FOR EMERGENT TRANSPORT OVER 50 MILES ONE-WAY","M62","Missing/incomplete/invalid treatment authorization code.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["UBD","UNBUNDLED PROCEDURE.  MORE APPROPRIATE CODE AVAILABLE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["UBF","FACILITY NOT ALLOWED TO BILL ON A UB CLAIM FORM","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IUBP","Units greater than one for bilateral procedure billed with modifier 50 are not appropriate","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IUNB","Procedure code billed has either an incidental, exclusive, or unbundle relationship with the procedure code on the current claim or a claim in this patient's history and can not be billed as a stand alone code.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["IUNL","PROCEDURE CODE IS AN UNLISTED CODE. PLEASE SUBMIT DOCUMENTATION FOR REVIEW OF PROCEDURE PERFORMED.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","189","Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service"]
["UNLI","PROCEDURE CODE IS AN UNLISTED CODE. PLEASE SUBMIT DOCUMENTATION FOR REVIEW OF PROCEDURE PERFORMED. PLEASE SUBMIT TO: MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200, PO BOX 1121, LEWISTON, ME 04243.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IUOR","CODE ALLOWED IF ON DIFFERENT PARTS OF BODY .","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["US2","SERVICES ARE LIMITED TO 2 OBSTETRIC ULTRASOUNDS PER PREGNANCY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["IVAC","VACCINE CODES MUST BE BILLED IN CORRECT ORDER.","N349","The administration method and drug must be reported to adjudicate this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["IVAL","INVALID VALUE CODE","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["VBID","COST SHARING WAIVED DUE TO CHRONIC ILLNESS SUPPORT PROGRAM.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["VHRD","VISION HARDWARE LIMITED TO $150.00 BENEFITS ALLOWED. MEMBER MAY BE RESPONSIBLE FOR CHARGES OVER THIS AMOUNT.","","","OA","OA Other adjustments","119","Benefit maximum for this time period or occurrence has been reached."]
["MODI","THE MODIFIER BILLED IS INAPPROPRIATE FOR THIS CPT CODE.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["WNC","WAIVER SERVICES NOT COVERED UNDER BENEFIT PLAN.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["WNCI","WAIVER SERVICES NOT COVERED UNDER HBIA/HBIS PLAN","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["ZDNF","THIS DEPENDENT UNDER AGE 1 WAS NOT FOUND IN ELIGIBILITY.","N30","Patient ineligible for this service.","PR","PR Patient Responsibility","32","Our records indicate the patient is not an eligible dependent."]
["ZPGP","THIS MEMBER'S ELIGIBILITY IS PAST THE GRACE PERIOD PAID THROUGH DATE","N30","Patient ineligible for this service.","OA","OA Other adjustments","32","Our records indicate the patient is not an eligible dependent."]
["X1","ADMISSION DIAGNOSIS: THE ADMISSION DIAGNOSIS IS INVALID OR DISABLED.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y1","ADMISSION DIAGNOSIS: THE ADMISSION DIAGNOSIS IS INVALID OR DISABLED.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y10","ADMISSION DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS AGE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X10","ADMISSION DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS AGE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X100","E/M CONDITION NOT MET AND LINE ITEM DATE FOR OBS CODE G0244 IS NOT 12/31 OR 1/1","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X101","COMPOSITE E/M CONDITION NOT MET FOR OBSERVATION AND LINE ITEM DATE FOR CODE G0378 IS 1/1","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X102","G0379 ONLY ALLOWED WITH G0378","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X103","CLINICAL TRIAL REQUIRES DIAGNOSIS CODE V707 AS OTHER THAN PRIMARY DIAGNOSIS","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X104","USE OF MODIFIER CA WITH MORE THAN ONE PROCEDURE NOT ALLOWED","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X105","SERVICE CAN ONLY BE BILLED TO THE DMERC","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X106","CODE NOT RECOGNIZED BY OPPS; ALTERNATE CODE FOR SAME SERVICE MAY BE AVAILABLE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X107","THIS OT CODE ONLY BILLED ON PARTIAL HOSPITALIZATION CLAIMS","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X108","AT SERVICE NOT PAYABLE OUTSIDE THE PARTIAL HOSPITALIZATION PROGRAM","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X109","REVENUE CODE NOT RECOGNIZED BY MEDICARE","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X11","PRINCIPAL DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS AGE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y11","PRINCIPAL DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS AGE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X110","CODE REQUIRES MANUAL PRICING","N10","Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X111","SERVICE PROVIDED PRIOR TO FDA APPROVAL","","","CO","Contractual Obligations","188","This product/procedure is only covered when used according to FDA recommendations."]
["X112","SERVICE PROVIDED PRIOR TO DATE OF NATIONAL COVERAGE DETERMINATION (NCD) APPROVAL","N386","This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X113","SERVICE PROVIDED OUTSIDE APPROVAL PERIOD","N351","Service date outside of the approved treatment plan service dates.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X114","CA MODIFIER REQUIRES PATIENT STATUS CODE 20","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X115","CLAIM LACKS REQUIRED DEVICE CODE","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X116","SERVICE NOT BILLABLE TO THE FISCAL INTERMEDIARY/MEDICARE ADMINISTRATIVE CONTRACTOR","N479","Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["X117","INCORRECT BILLING OF BLOOD AND BLOOD PRODUCTS","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X118","UNITS GREATER THAN ONE FOR BILATERAL PROCEDURE BILLED WITH MODIFIER 50","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X119","INCORRECT BILLING OF MODIFIER FB OR FC","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y12","OTHER DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS AGE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X12","OTHER DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS AGE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X120","TRAUMA RESPONSE CRITICAL CARE CODE WITHOUT REVENUE CODE 068X AND CPT 99291","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["L120","SERVICE EXCEEDS QUANTITY LIMITATIONS. T4535 ARE LIMITED TO 120 EVERY 30 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X121","CLAIM LACKS ALLOWED PROCEDURE CODE","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X122","CLAIM LACKS REQUIRED RADIOLABELED PRODUCT","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X123","INCORRECT BILLING OF REVENUE CODE WITH HCPCS CODE","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","199","Revenue code and Procedure code do not match."]
["X124","MENTAL HEALTH CODE NOT APPROVED FOR PARTIAL HOSPITALIZATION","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X125","MENTAL HEALTH SERVICE NOT PAYABLE OUTSIDE THE PARTIAL HOSPITALIZATION PROGRAM","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X126","CHARGE EXCEEDS TOKEN CHARGE ($1.01)","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["X127","SERVICE PROVIDED ON OR AFTER EFFECTIVE DATE OF NCD NON-COVERAGE","N30","Patient ineligible for this service.","CO","Contractual Obligations","27","Expenses incurred after coverage terminated."]
["X128","Claim lacks required primary code","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X129","Claim lacks required device code or required procedure code","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X13","ADMISSION DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS GENDER.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y13","ADMISSION DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS GENDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X130","Manifestation code not allowed as principal diagnosis","MA66","Missing/incomplete/invalid principal procedure code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X131","Skin substitute application procedure without appropriate skin substitute product code","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X132","payment code not reported for FQHC claim","M79","Missing/incomplete/invalid charge.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X133","FQHC claim lacks required qualifying visit code","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X134","Incorrect revenue code reported for FQHC payment code","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X135","Item or service not covered under FQHC PPS","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X136","Device-dependent procedure reported without device code","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X137","PER MEDICARE'S UNLIKELY EDITS POLICY, THE UNITS OF SERVICE BILLED FOR THE PROCEDURE EXCEEDS THE ALLOWED UNITS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X138","Item or service expected to be denied as not reasonable and necessary.","N227","Incomplete/invalid Certificate of Medical Necessity.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X139","MULTIPLE MEDICAL VISITS (BASED ON UNITS AND/OR LINES) ARE PRESENT ON THE SAME DAY WITH THE SAME REVENUE CODE, WITHOUT CONDITION CODE G0 TO INDICATE THAT THE VISITS WERE DISTINCT AND INDEPENDENT OF EACH OTHER","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y14","PRINCIPAL DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS GENDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X14","PRINCIPAL DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS GENDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X142","THE HISTORICAL PROCEDURE CODE SHOULD BE REVIEWED FOR A POTENTIAL MULTIPLE PROCEDURE REDUCTION.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X143","This service is not appropriate for medicare patients in an ambulatory surgery center setting","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X144","Service does not meet the guidelines for TOB 14x.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y145","The taxonomy of the provider does not match the bill type.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X146","The surgical procedure code has been crosswalked to an anesthesia procedure code for analysis of the claim.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y147","THE PROCEDURE WAS BILLED BY A PROVIDER NOT LISTED AS AN ANESTHESIOLOGY PROVIDER.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X147","THE PROCEDURE WAS BILLED BY A PROVIDER NOT LISTED AS AN ANESTHESIOLOGY PROVIDER.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X148","AN ANESTHESIA SERVICE WITH AN EQUAL OR HIGHER BASE UNIT VALUE WAS BILLED ON PREVIOUS CLAIM. ONLY THE ANESTHESIA CODE WITH THE HIGHER BASE UNIT VALUE SHOULD BE BILLED PER OPERATIVE SESSION.","N633","Additional anesthesia time units are not allowed.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X149","HISTORICAL - AN ANESTHESIA SERVICE WITH AN EQUAL OR HIGHER BASE UNIT VALUE  WAS BILLED ON A PREVIOUS CLAIM. ONLY THE ANESTHESIA CODE WITH THE HIGHER BASE UNIT VALUE SHOULD BE BILLED PER OPERATIVE SESSION.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y15","OTHER DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS GENDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X15","OTHER DIAGNOSIS IS NOT TYPICAL FOR A PATIENT OF THIS GENDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X150","THE SYSTEM WAS UNABLE TO CROSSWALK THE SURGICAL CODE TO AN ANESTHESIA CODE SINCE THE ANESTHESIA CROSSWALK STATUS IS BY REPORT. REVIEW THE CLAIM AND ENTER THE APPROPRIATE ANESTHESIA CODE IN PLACE OF THE SURGICAL CPT CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X151","THE PROCEDURE CODE REQUIRES A CROSSWALK TO AN ANESTHESIA CODE PRIOR TO EDITING.  REPLACE THE SURGICAL CPT CODE WITH THE APPROPRIATE ANESTHESIA CODE.","N29","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X152","ANESTHESIA MODIFIER REDUCTION POLICY (THE MODIFIER ON THIS CLAIM LINE INDICATES THE SERVICE SHOULD BE REIMBURSED AT AGREED PERCTANGE OF FEE SCHEDULE AMOUNT .)","","","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X153","ANESTHESIA CODE ON THIS LINE REQUIRES AN APPROPRIATE MODIFIER.","N13","Payment based on professional/technical component modifier(s).","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X154","PAYMENT FOR THE PROCEDURE CODE IS ALWAYS BUNDLED INTO PAYMENT FOR OTHER SERVICES NOT SPECIFIED AND NO SEPARATE PAYMENT IS MADE, PER MEDICARE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X155","PER MEDICARE GUIDELINES THE PROCEDURE CODE IS AN ITEM OR SERVICE THAT HAS NO SEPARATE PAYMENT UNDER THE PHYSICIAN FEE SCHEDULE.","N390","This service/report cannot be billed separately.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X156","MEDICARE CONSIDERS THE PROCEDURE CODE AS A BUNDLED SERVICE WHEN OTHER PAYABLE SERVICES ARE BILLED ON THE SAME DAY BY THE SAME PROVIDER.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X157","PER CCI GUIDELINES, PROCEDURE CODE HAS AN UNBUNDLE RELATIONSHIP WITH PROCEDURE CODE WITH ANOTHER CODE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X158","PER CCI GUIDELINES, HISTORY PROCEDURE CODE ON HISTORY CLAIM HAS AN UNBUNDLE RELATIONSHIP WITH THE PROCEDURE CODE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X159","PER MEDICARE GUIDELINES, THE PROCEDURE CODE IS BUNDLED WITH AN ALL INCLUSIVE AMBULANCE SERVICE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X16","A MANIFESTATION CODE CAN NOT BE USED AS THE ADMITTING DIAGNOSIS.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y16","A MANIFESTATION CODE CAN NOT BE USED AS THE ADMITTING DIAGNOSIS.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y160","ADULT/MATERNITY/NEWBORN/PEDIATRIC DIAGNOSIS IS NOT TYPICAL FOR THE PATIENT'S AGE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X160","ADULT/MATERNITY/NEWBORN/PEDIATRIC DIAGNOSIS IS NOT TYPICAL FOR THE PATIENT''S AGE.","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X161","THE DIAGNOSIS IS INVALID OR DISABLED.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["Y161","THE DIAGNOSIS IS INVALID OR DISABLED.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y162","THERE IS NO PRIMARY DIAGNOSIS LISTED FOR THIS PROCEDURE.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X162","THERE IS NO PRIMARY DIAGNOSIS LISTED FOR THIS PROCEDURE.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X163","THE DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES MORE DIGITS","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y163","THE DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES A FOURTH AND/OR FIFTH DIGIT.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y164","THE DIAGNOSIS IS NOT TYPICAL FOR THE PATIENT'S GENDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X164","THE DIAGNOSIS IS NOT TYPICAL FOR THE PATIENT''S GENDER.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X165","THE DIAGNOSIS DESCRIBES AN EXTERNAL CAUSE, OR REQUIRES THE ICD CODE FOR THE FIRST UNDERLYING DISEASE, AND AND SHOULD NEVER BE USED AS THE PRIMARY DIAGNOSIS FOR A PROCEDURE.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y165","THE DIAGNOSIS DESCRIBES AN EXTERNAL CAUSE, OR REQUIRES THE ICD CODE FOR THE FIRST UNDERLYING DISEASE, AND SHOULD NEVER BE USED AS THE PRIMARY DIAGNOSIS FOR A PROCEDURE.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X166","THE DIAGNOSIS CODE COULD INVOLVE THIRD PARTY LIABILITY AND/OR SUBROGATION OF BENEFITS","","","CO","Contractual Obligations","20","This injury/illness is covered by the liability carrier."]
["X167","USE OF MODIFIER 59 MAY REQUIRE SUPPORTING DOCUMENTATION","","","CO","Contractual Obligations","251","The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["Y17","A MANIFESTATION CODE CAN NOT BE USED AS THE PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X17","A MANIFESTATION CODE CAN NOT BE USED AS THE PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X173","THE E/M CODE WAS BILLED ON THE SAME DATE OF SERVICE OR ONE DAY PRIOR TO A DIFFERENT PROCEDURE WITHOUT AN APPROPRIATE MODIFIER.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X174","SAME CLAIM - THE E/M CODE WAS BILLED ON THE SAME DATE OF SERVICE OR ONE DAY PRIOR TO A DIFFERENT PROCEDURE WITHOUT AN APPROPRIATE MODIFIER.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y174","SAME CLAIM - THE E/M CODE WAS BILLED ON THE SAME DATE OF SERVICE OR ONE DAY PRIOR TO A DIFFERENT PROCEDURE WITHOUT AN APPROPRIATE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X175","THIS PATIENT RECEIVED CARE BY PROVIDER WITHIN THE LAST THREE YEARS. AN ESTABLISHED PATIENT E/M CODE SHOULD HAVE BEEN USED.","N113","Only one initial visit is covered per physician, group practice or provider.","CO","Contractual Obligations","B16","New Patient' qualifications were not met."]
["X176","ONLY ONE E&M SERVICE MAY BE REPORTED UNLESS THE EVALUATION AND MANAGEMENT SERVICES ARE FOR UNRELATED PROBLEMS.","","","CO","Contractual Obligations","B14","Only one visit or consultation per physician per day is covered."]
["X177","THE PROCEDURE WAS BILLED ON THE SAME DATE OF SERVICE OR ONE DAY PRIOR TO AN E/M CODE WITHOUT AN APPROPRIATE MODIFIER.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X178","THE E&M PROCEDURE CODE IS WITHIN THE GLOBAL PERIOD OF THE DAYS OF THE PROCEDURE CODE PERFORMED, BY THE SAME PROVIDER. THE DIAGNOSIS INDICATES IT IS FOR THE SAME CONDITION.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X18","THE PRINCIPAL DIAGNOSIS IS NOT NORMALLY SUFFICIENT JUSTIFICATION FOR ADMISSION TO A HOSPITAL.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y18","THE PRINCIPAL DIAGNOSIS IS NOT NORMALLY SUFFICIENT JUSTIFICATION FOR ADMISSION TO A HOSPITAL.","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X180","THE PROCEDURE IS WITHIN THE GLOBAL PERIOD OF DAYS OF THE PROCEDURE CODE WAS PERFORMED, BY THE SAME PROVIDER. THE DIAGNOSIS INDICATES IT IS FOR THE SAME CONDITION.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y19","THE DIAGNOSIS CODE IS NOT ACCEPTABLE AS A PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X19","THE DIAGNOSIS CODE IS NOT ACCEPTABLE AS A PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X190","DISCREPANCY DETECTED BETWEEN THE NUMBER OF UNITS ON THIS CLAIM LINE AND THE DIFFERENCE BETWEEN BEGINNING AND ENDING DATES OF SERVICE.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X192","THE MODIFIER CANNOT BE ON THE SAME LINE AS OTHER MODIFIERS.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y193","THE MODIFIER IS DISABLED/NOT VALID","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X193","THE MODIFIER IS DISABLED/NOT VALID","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X2","PRINCIPAL DIAGNOSIS: THE PRINCIPAL DIAGNOSIS IS INVALID OR DISABLED.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y2","PRINCIPAL DIAGNOSIS: THE PRINCIPAL DIAGNOSIS IS INVALID OR DISABLED.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y20","THE DIAGNOSIS CODE IS NOT ACCEPTABLE AS A PRINCIPAL DIAGNOSIS UNLESS A SECONDARY DIAGNOSIS IS PRESENT.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X20","THE DIAGNOSIS CODE IS NOT ACCEPTABLE AS A PRINCIPAL DIAGNOSIS UNLESS A SECONDARY DIAGNOSIS IS PRESENT.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X207","THE PRESENCE OF MODIFIER GZ INDICATES THIS IS NOT ELIGIBLE FOR PAYMENT.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X208","PER MEDICARE GUIDELINES, THE HCPCS CODE IS IDENTIFIED AS AN AMBULANCE CODE AND REQUIRES AN AMBULANCE MODIFIER APPENDED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y208","PER MEDICARE GUIDELINES, THE HCPCS CODE IS IDENTIFIED AS AN AMBULANCE CODE AND REQUIRES AN AMBULANCE MODIFIER APPENDED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y209","THE DIAGNOSTIC PROCEDURE CODE BILLED BY A PHYSICIAN REQUIRES A 26 MODIFIER WHEN PERFORMED IN A FACILITY SETTING. MODIFIER 26 WAS ADDED TO THIS PROCEDURE. PAYMENT MAY BE REDUCED TO PROFESSIONAL COMPONENT.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X209","THE DIAGNOSTIC PROCEDURE CODE BILLED BY A PHYSICIAN REQUIRES A 26 MODIFIER WHEN PERFORMED IN A FACILITY SETTING. MODIFIER 26 WAS ADDED TO THIS PROCEDURE. PAYMENT MAY BE REDUCED TO PROFESSIONAL COMPONENT.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X21","HAC STATUS: ONE OR MORE HAC CRITERIA MET, FINAL DRG CHANGES","N647","Adjusted based on diagnosis-related group (DRG).","CO","Contractual Obligations","A8","Ungroupable DRG."]
["Y21","HAC STATUS: ONE OR MORE HAC CRITERIA MET, FINAL DRG CHANGES","N647","Adjusted based on diagnosis-related group (DRG).","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y210","THE PAYMENT MODIFIER IS REQUIRED TO BE IN THE FIRST POSITION WHEN BILLED UNLESS ANOTHER PAYMENT MODIFIER IS SUBMITTED IN THE FIRST POSITION.","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X210","THE PAYMENT MODIFIER IS REQUIRED TO BE IN THE FIRST POSITION WHEN BILLED UNLESS ANOTHER PAYMENT MODIFIER IS SUBMITTED IN THE FIRST POSITION.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X211","THE PROCEDURE CODE DOES NOT TYPICALLY REQUIRE PERFORMANCE BY A PHYSICIAN IN PLACE OF SERVICE SPECIFIED PER MEDICARE GUIDELINES.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X212","THE PROCEDURE CODE IS A PHYSICAL THERAPY SERVICE. NO PAYMENT IS MADE IF PROVIDED IN PLACE OF SERVICE SPECIFIED TO MEDICARE GUIDELINES.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X214","THE PROCEDURE CODE HAS BEEN DELETED OR NOT VALID.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["X215","THE PRIMARY PROCEDURE CODE IN HISTORY THAT IS ASSOCIATED WITH THIS ADD-ON HAS RECEIVED AN EDIT WITH A DENY OR REVIEW STATUS.","","","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X216","THE PROCEDURE CODE IS NOT COVERED BY MEDICARE.","","","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X217","THE PROCEDURE CODE IS NOT VALID FOR MEDICARE PURPOSES.","N643","The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X218","THE ADD-ON PROCEDURE CODE HAS BEEN SUBMITTED WITHOUT AN APPROPRIATE PRIMARY PROCEDURE","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["Y22","THE PRINCIPAL DIAGNOSIS CODE INDICATES THAT A WRONG PATIENT PROCEDURE WAS PERFORMED","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X22","THE PRINCIPAL DIAGNOSIS CODE INDICATES THAT A WRONG PATIENT PROCEDURE WAS PERFORMED","N350","Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X220","THE PROCEDURE CODE IS AN UNLISTED PROCEDURE OR SERVICE","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","189","Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service"]
["X221","THE PROCEDURE CODE IS NOT REIMBURSED BY MEDICARE.","N607","Service provided for non-compensable condition(s).","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X222","THE PROCEDURE CODE IS PART OF A BILATERAL PROCEDURE AND A REDUCTION WAS APPLIED.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X223","THIS PROCEDURE CODE INDICATES THAT MULTIPLE SERVICES WERE PERFORMED. PER CMS, A REDUCTION OF TECHNICAL COMPONENT APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X224","THIS PROCEDURE CODE QUALIFIES FOR A MULTIPLE ENDOSCOPY REDUCTION AND PAYMENT SHOULD BE REDUCED BY THE VALUE OF BASE ENDOSCOPY CODE. THE RVU VALUE FOR THIS LINE SHOULD BE REDUCED BY THE RVU VALUE FOR THE BASE ENDOSCOPY.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X225","MEDICARE REQUIRES THAT AN OPERATIVE REPORT BE SUBMITTED WHEN MORE THAN 5 PROCEDURES HAVE BEEN PERFORMED ON THE SAME DATE OF SERVICE.","M29","Missing operative note/report.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["X226","PER CMS GUIDELINES, THE PRESENSE OF MODIFIER 54 INDICATES THAT ONLY INTRA-OPERATIVE PORTION OF THE GLOBAL FEE SHOULD BE REIMBURESED.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X227","PER CMS GUIDELINES, THE PRESENSE OF MODIFIER 55 INDICATES THAT ONLY POST-OPERATIVE PORTION OF THE GLOBAL FEE SHOULD BE REIMBURESED.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X228","PER CMS GUIDELINES, THE PRESENSE OF MODIFIER 56 INDICATES THAT ONLY PRE-OPERATIVE PORTION OF THE GLOBAL FEE SHOULD BE REIMBURESED.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X229","PER CMS GUIDELINES, THE PRESENSE OF MODIFIER 78 INDICATES THAT ONLY INTRA-OPERATIVE PORTION OF THE GLOBAL FEE SHOULD BE REIMBURESED.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X23","THE OTHER DIAGNOSIS CODE INDICATES THAT A WRONG PATIENT PROCEDURE WAS PERFORMED","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y23","THE OTHER DIAGNOSIS CODE INDICATES THAT A WRONG PATIENT PROCEDURE WAS PERFORMED","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X239","GENERAL SYSTEM ERROR","M81","You are required to code to the highest level of specificity.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y24","THE ADMISSION DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES A FOURTH AND/OR FIFTH DIGIT.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X24","THE ADMISSION DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES A FOURTH AND/OR FIFTH DIGIT.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X240","NPI PROVIDER INFO NOT FOUND","","","CO","Contractual Obligations","208","National Provider Identifier - Not matched."]
["X241","FEDERAL/STATE PROGRAM RATE IS NOT FOUND.","","","CO","Contractual Obligations","147","Provider contracted/negotiated rate expired or not on file."]
["X243","NPI IS NOT VALID.","","","CO","Contractual Obligations","207","National Provider identifier - Invalid format"]
["X245","WAGE INDEX FOR THIS CLAIM IS NOT DEFINED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X246","MEDICAID/PROGRAM STATE FACTOR FOR THIS CLAIM IS NOT DEFINED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X25","THE PRINCIPAL DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES A FOURTH AND/OR FIFTH DIGIT.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y25","THE PRINCIPAL DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES A FOURTH AND/OR FIFTH DIGIT.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X250","ADMIT/STATEMENT FROM DATE MISSING OR NOT VALID","MA40","Missing/incomplete/invalid admission date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X251","DISCHARGE/STATEMENT TO DATE IS MISSING OR NOT VALID.","N318","Missing/incomplete/invalid discharge or end of care date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X252","ADMIT/STATEMENT FROM DATE CANNOT BE GREATER THAN THE DISCHARGE/STATEMENT DATE.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X253","DISCHARGE/STATEMENT DATE EXCEEDS THE MAXIMUM 12 MONTHS STATUTORY REQUIREMENT FOR TIMELY FILING.","","","CO","Contractual Obligations","29","The time limit for filing has expired."]
["X255","DATE OF BIRTH IS MISSING OR INVALID","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X256","THE VALUE CODE(S) PRESENT ON THE CLAIM ARE NOT VALID","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X257","THE CONDITION CODE(S) PRESENT ON THE CLAIM ARE NOT VALID.","M44","Missing/incomplete/invalid condition code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X258","SOURCE OF ADMISSION IS MISSING OR NOT VALID.","MA42","Missing/incomplete/invalid admission source.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X259","TYPE OF ADMISSION IS MISSING OR NOT VALID.","MA41","Missing/incomplete/invalid admission type.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y26","THE OTHER DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES A FOURTH AND/OR FIFTH DIGIT.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X26","THE OTHER DIAGNOSIS IS A NONSPECIFIC DIAGNOSIS CODE AND REQUIRES A FOURTH AND/OR FIFTH DIGIT.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X260","PATIENT GENDER IS MISSING OR NOT VALID.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X261","PLACE OF SERVICE IS MISSING OR NOT VALID.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X262","ONLY ONE PRINCIPAL DIAGNOSIS IS ALLOWED PER CLAIM.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X263","ONLY ONE PRINCIPAL PROCEDURE IS ALLOWED PER CLAIM.","MA66","Missing/incomplete/invalid principal procedure code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X264","AGE IS INVALID; NOT IN RANGE OF 0 - 124 YEARS.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X266","NPI IS MISSING OR NOT VALID.","","","CO","Contractual Obligations","208","National Provider Identifier - Not matched."]
["X27","THERE IS NO ADMISSION DIAGNOSIS LISTED FOR THIS PROCEDURE.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y27","THERE IS NO ADMISSION DIAGNOSIS LISTED FOR THIS PROCEDURE.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X272","AMBULANCE CLAIM BILLED ON A HCFA REQUIRES A VALID PICK UP LOCATION ZIP CODE.","N53","Missing/incomplete/invalid point of pick-up address.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y28","THERE IS NO PRINCIPAL DIAGNOSIS LISTED FOR THIS PROCEDURE.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X28","THERE IS NO PRINCIPAL DIAGNOSIS LISTED FOR THIS PROCEDURE.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X29","THE PRINCIPAL DIAGNOSIS CODE IS NON-EXEMPT AND REQUIRES A VALID POA INDICATOR.","N434","Missing/Incomplete/Invalid Present on Admission indicator.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y29","THE PRINCIPAL DIAGNOSIS CODE IS NON-EXEMPT AND REQUIRES A VALID POA INDICATOR.","N434","Missing/Incomplete/Invalid Present on Admission indicator.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y296","Co-Surgeon modifier 62 indicates a 50% reduction of the state maximum shoud be applied.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X296","Co-Surgeon modifier 62 indicates a 50% reduction of the state maximum shoud be applied.","N670","This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X297","Co-Surgeon modifier 62 not applicable for procedure code. Line item not reimbursed.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y297","Co-Surgeon modifier 62 not applicable for procedure code. Line item not reimbursed.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X299","Assistant Surgeon modifier not applicable for procedure code. Line item not reimbursed.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y299","Assistant Surgeon modifier not applicable for procedure code. Line item not reimbursed.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y3","OTHER DIAGNOSIS: THE OTHER DIAGNOSIS IS INVALID OR DISABLED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X3","OTHER DIAGNOSIS: THE OTHER DIAGNOSIS IS INVALID OR DISABLED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X30","THE OTHER DIAGNOSIS CODE IS NON-EXEMPT AND REQUIRES A VALID POA INDICATOR.","N434","Missing/Incomplete/Invalid Present on Admission indicator.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y30","THE OTHER DIAGNOSIS CODE IS NON-EXEMPT AND REQUIRES A VALID POA INDICATOR.","N434","Missing/Incomplete/Invalid Present on Admission indicator.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y300","Lab Panel reduction applied to line item.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X300","Lab Panel reduction applied to line item.","N670","This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X301","Code is part of Panel billed on same day. Line item not reimbursed.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y301","Code is part of Panel billed on same day. Line item not reimbursed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y302","The Procedure code is reimbursed under an alternate therapy procedure code for therapists. The Procedure code was crosswalked.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X302","The Procedure code is reimbursed under an alternate therapy procedure code for therapists. The Procedure code was crosswalked.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X303","Modifier 26 billed for a code that does not have a professional component per the fee schedule.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y303","Modifier 26 billed for a code that does not have a professional component per the fee schedule.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X305","UNITS EXCEEDS STATE MAXIMUM ALLOWED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["Y305","UNITS EXCEEDS STATE MAXIMUM ALLOWED.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y306","Dasa Services billed with unacceptable primary diagnosis. Acceptable primary diagnosis codes: F10-F19.99 (ICD9: 303-305.93)","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X306","Dasa Services billed with unacceptable primary diagnosis. Acceptable primary diagnosis codes: F10-F19.99 (ICD9: 303-305.93)","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X307","HOSPICE (K17): Hospice Services provided for 61 or more days.  Rates for Routine Home Care will be based on low rate.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["Y307","HOSPICE (K17): Hospice Services provided for 61 or more days.  Rates for Routine Home Care will be based on low rate.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["Y308","HOSPICE (K16): Service Intensity Add-on Billing Invalid:     1. 055X or 056X is billed but the Patient Status is not equal to 20, 40, or 42    2. The claim contains Revenue Codes 055X or 056X but does not contain Revenue","MA43","Missing/incomplete/invalid patient status.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X308","HOSPICE (K16): Service Intensity Add-on Billing Invalid:     1. 055X or 056X is billed but the Patient Status is not equal to 20, 40, or 42    2. The claim contains Revenue Codes 055X or 056X but does not contain Revenue","MA43","Missing/incomplete/invalid patient status.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X309","HOSPICE: REVENUE CODE(S) REQUIRES THAT VALUE CODE SPECIFYING THE CORE BASED STATISTIC AREA (CBSA).","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y309","HOSPICE: REVENUE CODE(S) REQUIRES THAT VALUE CODE SPECIFYING THE CORE BASED STATISTIC AREA (CBSA).","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y31","THE PRINCIPAL PROCEDURE CODE IS INVALID OR DISABLED.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X31","THE PRINCIPAL PROCEDURE CODE IS INVALID OR DISABLED.","MA66","Missing/incomplete/invalid principal procedure code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X310","Dasa Services require a Value Code of 80 specifying the number of covered treatment days.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y310","Dasa Services require a Value Code of 80 specifying the number of covered treatment days.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y311","PROCEDURE CODE REQUIRES THAT AN NDC MUST BE BILLED ACCORDING TO NDC BILLING GUIDELINES.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X311","PROCEDURE CODE REQUIRES THAT AN NDC MUST BE BILLED ACCORDING TO NDC BILLING GUIDELINES.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X312","EAPG- EXTERNAL CAUSE OF MORBIDITY CODE CANNOT BE USED AS PRIMARY OR PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y312","EAPG- EXTERNAL CAUSE OF MORBIDITY CODE CANNOT BE USED AS PRIMARY OR PRINCIPAL DIAGNOSIS.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y313","EAPG- INVALID PROCEDURE CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X313","EAPG- INVALID PROCEDURE CODE.","","","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["X314","EAPG- SERVICE CONSIDERED AN INPATIENT PROCEDURE.","N676","Service does not qualify for payment under the Outpatient Facility Fee Schedule.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y314","EAPG- Invalid procedure code.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y315","EAPG - NCCI MEDICARE FAC - PROCEDURE CODE PAIR CONFLICT.  COMBINATION IS NOT ALLOWED EVEN IF APPROPRIATE MODIFIER IS PRESENT","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X315","EAPG - NCCI MEDICARE FAC - PROCEDURE CODE PAIR CONFLICT.  COMBINATION IS NOT ALLOWED EVEN IF APPROPRIATE MODIFIER IS PRESENT","","","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["X316","EAPG- MEDICAL VISITS REPORTED WITHOUT MODIFIER -25 OR -27 ON THE SAME DAY AS A SIGNIFICANT PROCEDURE.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y316","EAPG- MEDICAL VISITS REPORTED WITHOUT MODIFIER -25 OR -27 ON THE SAME DAY AS A SIGNIFICANT PROCEDURE.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y317","EAPG- MODIFIER IS INVALID.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X317","EAPG- MODIFIER IS INVALID.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X318","EAPG- From date is out of date range for grouper.","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y318","EAPG- From date is out of date range for grouper.","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y319","EAPG- Invalid age.","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X319","EAPG- Invalid age.","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X32","THE OTHER DIAGNOSIS CODE IS INVALID OR DISABLED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["Y32","THE OTHER DIAGNOSIS CODE IS INVALID OR DISABLED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y320","EAPG- Invalid sex.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X320","EAPG- Invalid sex.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X321","EAPG- REVENUE CODE IS INVALID.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y321","EAPG- REVENUE CODE IS INVALID.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X322","EAPG- REVENUE CODE IS REQUIRES HCPCS CODE ON SAME LINE.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X323","EAPG- UNITS OF SERVICE GREATER THAN ONE IS INAPPROPRIATE FOR BILATERAL PROCEDURE REPORTED WITH MODIFIER 50.","N430","Procedure code is inconsistent with the units billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y323","EAPG- Units of service greater than one is inappropriate for bilateral procedure reported with modifier 50.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y324","EAPG- Invalid diagnosis code, 4th or 5th digit required.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X324","EAPG- Invalid diagnosis code, 4th or 5th digit required.","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X325","EAPG- Invalid diagnosis code.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","146","Diagnosis was invalid for the date(s) of service reported."]
["Y325","EAPG- Invalid diagnosis code.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y326","EAPG- Age conflict - diagnosis considered only for newborns, age <1 year.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X326","EAPG- Age conflict - diagnosis considered only for newborns, age <1 year.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X327","EAPG- Age conflict - diagnosis considered only for pediatric patients, age <18 years","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y327","EAPG- Age conflict - diagnosis considered only for pediatric patients, age <18 years","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y328","EAPG- Age conflict - diagnosis considered only for maternity, females 12-55 years.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X328","EAPG- Age conflict - diagnosis considered only for maternity, females 12-55 years.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y329","EAPG- Age conflict - diagnosis considered only for adults, age 15 and up.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X329","EAPG- Age conflict - diagnosis considered only for adults, age 15 and up.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X33","THE PRINCIPAL PROCEDURE CODE IS NOT TYPICAL FOR THIS PATIENT GENDER.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y33","THE PRINCIPAL PROCEDURE CODE IS NOT TYPICAL FOR THIS PATIENT GENDER.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y330","EAPG- Sex conflict - diagnosis code is only valid for male patients.  May require condition code 45 to address ambiguous gender.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X330","EAPG- Sex conflict - diagnosis code is only valid for male patients.  May require condition code 45 to address ambiguous gender.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y332","EAPG- Sex conflict - diagnosis code is only valid for female patients.  May require condition code 45 to address ambiguous gender.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X332","EAPG- Sex conflict - diagnosis code is only valid for female patients.  May require condition code 45 to address ambiguous gender.","","","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X334","EAPG- Sex conflict - procedure only valid for male patients.  May require condition code 45 and modifier KX to address ambiguous gender.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y334","EAPG- Sex conflict - procedure only valid for male patients.  May require condition code 45 and modifier KX to address ambiguous gender.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y336","EAPG- Sex conflict - procedure only valid for female patients.  May require condition code 45 and modifier KX to address ambiguous gender.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X336","EAPG- Sex conflict - procedure only valid for female patients.  May require condition code 45 and modifier KX to address ambiguous gender.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X338","EAPG- From date is invalid or blank. This is a required field.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y338","EAPG- From date is invalid or blank. This is a required field.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y339","EAPG- Through date is invalid or blank. This is a required field.","M59","Missing/incomplete/invalid 'to' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X339","EAPG- Through date is invalid or blank. This is a required field.","M59","Missing/incomplete/invalid 'to' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X34","THE OTHER PROCEDURE CODE IS NOT TYPICAL FOR THIS PATIENT GENDER.","M67","Missing/incomplete/invalid other procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y34","THE OTHER PROCEDURE CODE IS NOT TYPICAL FOR THIS PATIENT GENDER.","M67","Missing/incomplete/invalid other procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y340","EAPG- Line item service date is invalid or blank. This is a required field.","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X340","EAPG- Line item service date is invalid or blank. This is a required field.","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X341","EAPG- Line item service date is not within the from-through dates.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y341","EAPG- Line item service date is not within the from-through dates.","MA31","Missing/incomplete/invalid beginning and ending dates of the period billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y342","EAPG- From date cannot be after through date.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X342","EAPG- From date cannot be after through date.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X343","EAPG- Terminated bilateral procedure. Do not use modifier -50 when reporting a terminated procedure.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y343","EAPG- Terminated bilateral procedure. Do not use modifier -50 when reporting a terminated procedure.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y344","EAPG- Terminated bilateral procedure. Do not use modifier -50 when reporting a terminated procedure.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X344","EAPG- Terminated bilateral procedure. Do not use modifier -50 when reporting a terminated procedure.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X345","EAPG- Primary or principal diagnosis code is blank; must be a valid code.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y345","EAPG- Primary or principal diagnosis code is blank; must be a valid code.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y346","EAPG- Type of bill is invalid, may affect claim processing.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X346","EAPG- Type of bill is invalid, may affect claim processing.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X347","EAPG- Duplicate lab or pathology code. Add modifier 59, 91, XE, XP, XS, or XU if documentation supports use. Otherwise duplicate code may not be paid.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y347","EAPG- Duplicate lab or pathology code. Add modifier 59, 91, XE, XP, XS, or XU if documentation supports use. Otherwise duplicate code may not be paid.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y349","EAPG- Duplicate radiology code. Add modifier if documentation supports use to differentiate services. Otherwise duplicate code may not be paid.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X349","EAPG- Duplicate radiology code. Add modifier if documentation supports use to differentiate services. Otherwise duplicate code may not be paid.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X35","PROCEDURE CODE IS NON-COVERED. THE BENEFICIARY IS OVER AGE 60.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y35","PROCEDURE CODE IS NON-COVERED. THE BENEFICIARY IS OVER AGE 60.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y350","EAPG- PRESENCE OF AN ANATOMIC SITE MODIFIER/OR CODE(s) IS SUPPRESSION NCCI EDIT. CHECK DOCUMENTATION TO DETERMINE WHETHER BOTH CODE PAIR(s) CAN BE BILLED OR AN ADDITIONAL SITE MODIFIER ADDED.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X350","EAPG- PRESENCE OF AN ANATOMIC SITE MODIFIER/OR CODE(s) IS SUPPRESSION NCCI EDIT. CHECK DOCUMENTATION TO DETERMINE WHETHER BOTH CODE PAIR(s) CAN BE BILLED OR AN ADDITIONAL SITE MODIFIER ADDED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["X351","EAPG- Presence of the same anatomic site modifier and code(s) is suppressing NCCI edit. Check documentation to verify use of same modifier. Otherwise one of the codes may not be paid.","N823","Incomplete/Invalid procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y351","EAPG- Presence of the same anatomic site modifier and code(s) is suppressing NCCI edit. Check documentation to verify use of same modifier. Otherwise one of the codes may not be paid.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y352","EAPG- Inherent bilateral code, report code once.  Do not report with modifier -50.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X352","EAPG- Inherent bilateral code, report code once.  Do not report with modifier -50.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X353","EAPG- Multiple E/M codes same day without modifier -27. Evaluate adding to second and subsequent E/M codes.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y353","EAPG- Multiple E/M codes same day without modifier -27. Evaluate adding to second and subsequent E/M codes.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y354","EAPG- Inherent bilateral procedure. Consider removing modifier -50 from this code.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X354","EAPG- Inherent bilateral procedure. Consider removing modifier -50 from this code.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X355","EAPG- Duplicate lab or pathology code.  Add modifier 59, 91, XE, XP, XS, or XU if documentation supports use.  Otherwise duplicate code may not be paid.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y355","EAPG- Duplicate lab or pathology code.  Add modifier 59, 91, XE, XP, XS, or XU if documentation supports use.  Otherwise duplicate code may not be paid.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y357","EAPG- ADD ON CODE REPORTED WITHOUT BASED PROCEDURE.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X357","EAPG- ADD ON CODE REPORTED WITHOUT BASE PROCEDURE.","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","B15","This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X358","EAPG- Modifier -25 is reported for a Medical Visit EAPG with no Significant Procedure EAPG present for the same date of service.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y358","EAPG- Modifier -25 is reported for a Medical Visit  EAPG with no Significant Procedure EAPG present for the same date of service.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y359","EAPG- DIAGNOSIS CODE IS REPORTED. ENSURE THAT MODIFIER PA, PB, OR PC IS ALSO REPORTED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X359","EAPG- DIAGNOSIS CODE IS REPORTED. ENSURE THAT MODIFIER PA, PB, OR PC IS ALSO REPORTED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X36","PROCEDURE CODE IS NON-COVERED. THE DESIGNATED DIAGNOSIS IS PRESENT.","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y36","PROCEDURE CODE IS NON-COVERED. THE DESIGNATED DIAGNOSIS IS PRESENT.","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y360","EAPG- MODIFIER PA, PB, OR PC IS REPORTED. ENSURE THAT DIAGNOSIS CODE IS ALSO REPORTED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X360","EAPG- MODIFIER PA, PB, OR PC IS REPORTED. ENSURE THAT DIAGNOSIS CODE IS ALSO REPORTED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X361","EAPG- Duplicate diagnostic or therapeutic procedures.  Add modifier if documentation supports use to differentiate services.  Otherwise duplicate code may not be paid.","","","OA","OA Other adjustments","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y361","EAPG- Duplicate diagnostic or therapeutic procedures.  Add modifier if documentation supports use to differentiate services.  Otherwise duplicate code may not be paid.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y362","EAPG- MODIFIER REPORTED FOR THIS CODE IS SUPPRESSING NCCI EDIT. REVIEW DOCUMENTATION TO DETERMINE IF THE MODIFIER SHOULD BE REPORTED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X363","EAPG- Revenue code reported requires Reason for Visit diagnosis code.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y363","EAPG- Revenue code reported requires Reason for Visit diagnosis code.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y364","EAPG- Modifier 59 is reported. Consider reporting modifier XE, XP, XS, or XU instead if more appropriate.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X364","EAPG- Modifier 59 is reported. Consider reporting modifier XE, XP, XS, or XU instead if more appropriate.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X365","EAPG- Units of service for ancillary observation hours must be reported in the range of 8 to 24 hours.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y365","EAPG- Units of service for ancillary observation hours must be reported in the range of 8 to 24 hours.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y367","EAPG- This mutually exclusive code is paired with another code to trigger edit 3019.","M80","Not covered when performed during the same session/date as a previously processed service for the patient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X367","EAPG- This mutually exclusive code is paired with another code to trigger edit 3019.","M80","Not covered when performed during the same session/date as a previously processed service for the patient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X368","EAPG- This mutually exclusive code is paired with another code to trigger edit 3020.","M80","Not covered when performed during the same session/date as a previously processed service for the patient.","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y368","EAPG- This mutually exclusive code is paired with another code to trigger edit 3020.","M80","Not covered when performed during the same session/date as a previously processed service for the patient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y369","EAPG- This mutually exclusive code is paired with another code to trigger edit 3039.","M80","Not covered when performed during the same session/date as a previously processed service for the patient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X369","EAPG- This mutually exclusive code is paired with another code to trigger edit 3039.","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X37","PROCEDURE CODE IS NON-COVERED. THE NO EXEMPTION CODE IS PRESENT ON CLAIM","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y37","PROCEDURE CODE IS NON-COVERED. THE NO EXEMPTION CODE IS PRESENT ON CLAIM","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y370","EAPG- This Column 1 code is paired with a Column 2 code to trigger edit 3040.","M80","Not covered when performed during the same session/date as a previously processed service for the patient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X370","EAPG- This Column 1 code is paired with a Column 2 code to trigger edit 3040.","","","CO","Contractual Obligations","231","Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X371","EAPG- Corneal transplant coded. Ensure that if appropriate, acquisition of the corneal tissue is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y371","EAPG- Corneal transplant coded. Ensure that if appropriate, acquisition of the corneal tissue is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y372","EAPG- Transfusion is coded. Ensure that blood and blood products transfused are also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X372","EAPG- Transfusion is coded. Ensure that blood and blood products transfused are also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X373","EAPG- Brachytherapy is coded. Ensure that brachytherapy seeds or radioelement is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y373","EAPG- Brachytherapy is coded. Ensure that brachytherapy seeds or radioelement is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y374","EAPG- Nuclear medicine is coded. Ensure that radiopharmaceuticals used in nuclear medicine procedures are also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X374","EAPG- Nuclear medicine is coded. Ensure that radiopharmaceuticals used in nuclear medicine procedures are also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X375","EAPG- Infusion therapy is coded. Ensure that the substance infused is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y375","EAPG- Infusion therapy is coded. Ensure that the substance infused is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y376","EAPG- Chemotherapy is coded. Ensure that chemotherapeutic agents and other supportive drugs are also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X376","EAPG- Chemotherapy is coded. Ensure that chemotherapeutic agents and other supportive drugs are also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X377","EAPG- Vaccination is coded. Ensure that the vaccine administered is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y377","EAPG- Vaccination is coded. Ensure that the vaccine administered is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y378","EAPG- Injection is coded. Ensure that the substance injected is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X378","EAPG- Injection is coded. Ensure that the substance injected is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X379","EAPG- Lens implant is coded. Ensure that the intraocular lens is also coded if applicable.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y379","EAPG- Lens implant is coded. Ensure that the intraocular lens is also coded if applicable.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y38","PROCEDURE CODE IS NON-COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X38","PROCEDURE CODE IS NON-COVERED.","N643","The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X380","EAPG- Neurostimulator implantation is coded. Ensure that the neurostimulator is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y380","EAPG- Neurostimulator implantation is coded. Ensure that the neurostimulator is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y381","EAPG- Insertion of prosthesis is coded. Ensure that the penile prosthesis is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X381","EAPG- Insertion of prosthesis is coded. Ensure that the penile prosthesis is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X382","EAPG- Radiology procedure with contrast is coded. Ensure that the contrast material is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y382","EAPG- Radiology procedure with contrast is coded. Ensure that the contrast material is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y383","EAPG- Interventional radiology procedure is coded. Ensure that the surgical intervention is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X383","EAPG- Interventional radiology procedure is coded. Ensure that the surgical intervention is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X384","EAPG- A 3D rendering radiology procedure is coded. Ensure that the base radiology procedure is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y384","EAPG- A 3D rendering radiology procedure is coded. Ensure that the base radiology procedure is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y385","EAPG- Surgical placement of device for clinical brachytherapy has been coded.  Ensure that application of brachytherapy source is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X385","EAPG- Surgical placement of device for clinical brachytherapy has been coded.  Ensure that application of brachytherapy source is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X386","EAPG- Skin substitute is coded.  Ensure that application of the skin substitute is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y386","EAPG- Skin substitute is coded.  Ensure that application of the skin substitute is also coded.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y387","EAPG - NCCI Medicaid FAC - Procedure code pair conflict is allowed if an appropriate NCCI modifier is present","N431","Not covered with this procedure.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X387","EAPG - NCCI Medicaid FAC - Procedure code pair conflict is allowed if an appropriate NCCI modifier is present","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X388","Corneal tissue processing reported without cornea transplant procedure","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X389","Biosimilar HCPCS reported without biosimilar modifier","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X390","Partial hospitalization claim span is equal to or more than 4 days with insufficient number of hours of service","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X391","Partial hospitalization interim claim from and through dates must span more than 4 days","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X392","Partial hospitalization services are required to be billed weekly","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X393","Claim with pass-through device, drug or biological lacks required procedure","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X394","Claim with pass-through or non-pass-through drug or biological lacks OPPS payable procedure","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y395","Duplicate Claim.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X396","Service is not separately billable for RHC/FQHC patients.","N390","This service/report cannot be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X397","Procedure code was billed with more than one assistant surgeon.  Only one surgical assistant is allowed per procedure.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y397","Procedure code was billed with more than one assistant surgeon.  Only one surgical assistant is allowed per procedure.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X398","Procedure code is not typical for a patient''s gender.","","","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X399","Procedure code is not typical for a patient's age.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y4","THE PATIENT AGE IS INVALID","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X4","THE PATIENT AGE IS INVALID","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X40","PROCEDURE CODE IS LIMITED COVERAGE OR IS ASSOCIATED WITH A LIMITED COVERAGE DIAGNOSIS CODE ON THE CLAIM.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X400","Procedure code typically does not require an assistant surgeon.","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X401","Procedure code is  allowed 1 unit per 6 rolling months for same provider/same diagnosis.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y402","T1015 procedure code must be billed as the first procedure code on the claim.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X402","T1015 procedure code must be billed as the first procedure code on the claim.","N182","This claim/service must be billed according to the schedule for this plan.","CO","Contractual Obligations","95","Plan procedures not followed."]
["X403","Claim does not contain the appropriate ER, observation or psychiatric clinic services for Illinois Medicaid.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","199","Revenue code and Procedure code do not match."]
["Y403","Claim does not contain the appropriate ER, observation or psychiatric clinic services for Illinois Medicaid.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X404","Bill type is incompatible with with revenue codes and/or services being billed.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X405","DOS must be no more than 7 days prior to the date of death.","N330","Missing/incomplete/invalid patient death date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X406","Home Health services provided outside of Indiana are non-covered services.","N424","Patient does not reside in the geographic area required for this type of payment.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X408","Outpatient services performed three days prior to inpatient admission.","","","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["X409","Procedure code is not appropriate for place of service.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y41","ICD-10: PROCEDURE CODE IS LIMITED COVERAGE OR IS ASSOCIATED WITH A LIMITED COVERAGE DIAGNOSIS CODE ON THE CLAIM.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X41","ICD-10: PROCEDURE CODE IS LIMITED COVERAGE OR IS ASSOCIATED WITH A LIMITED COVERAGE DIAGNOSIS CODE ON THE CLAIM.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X410","Procedure code is not appropriate for the age of the patient.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X411","Procedure code requires manual pricing.","N10","Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.","CO","Contractual Obligations","44","Prompt-pay discount."]
["X412","Procedure code requires that an NDC must be billed according to NDC billing guidelines.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X413","Taxonomy cannot bill in an outpatient hospital setting.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X414","The procedure code billed is an inpatient only code.","","","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X415","EPSDT claim requires one of the following CPT codes to be the first procedure code billed on the claim: 99381-99385 or 99391-99395.","N182","This claim/service must be billed according to the schedule for this plan.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X416","NDC billed is not in the proper format.  The NDC must be in the 5-4-2 configuration.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X417","A Multiple procedure reduction applies to procedure code.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X418","Procedure Code is part of a bi-latteral procedure and is paid at 150% of ASC grouping rate.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X419","Modifier indicates supervision of more than one procedure. Line is reimbursed at 30% of the physician fee schedule.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X42","THE PROCEDURE CODE SHOULD NOT BE REPORTED WHEN THE PATIENTâ\u0080\u0099S LENGTH OF STAY IS LESS THAN FOUR DAYS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y42","THE PROCEDURE CODE SHOULD NOT BE REPORTED WHEN THE PATIENTâ\u0080\u0099S LENGTH OF STAY IS LESS THAN FOUR DAYS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X420","Modifier indicates medical direction of service performed by CRNA. Line is reimbursed at 60% of the physician fee schedule.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X421","Modifier indicates a surgical assistant. Line is reimbursed at 20% of the physician fee schedule.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X422","Modifier indicates a co-surgeon. Line is reimbursed at 62.5% of the physician fee schedule.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X423","Taxonomy reimburses at a variable percentage of physician fee schedule.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X424","Place of Service reimbursed at a reduced rate. Line is reimbursed at 80% of the physician fee schedule.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X425","Service is packaged into another billed procedure.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X426","Modifier not applicable for procedure code. Line item not reimbursed.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X427","Bilateral procedure code with modifier 50 cannot exceed 1 unit.","N644","Reimbursement has been made according to the bilateral procedure rule.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X428","Code is not separately reimbursable.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X429","First 30 minutes of waiting time is not reimbursed.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X43","ASSIGN DRG ONLY IF MISSING ON INSTITUTIONAL INPATIENT CLAIM","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X430","Hospice rate reduction for services exceeding 60 days.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["X431","IHCP allows a maximum of one unit per service, per revenue code, per date of service.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X432","Medically High-Risk Diagnosis qualifies for an increase of $10 per visit.","","","CO","Contractual Obligations","B22","This payment is adjusted based on the diagnosis."]
["X433","Modifier HM indicates the service should be reimbursed at 75% of the fee schedule.","","","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X434","Modifier is not valid for the state of Indiana.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["X435","Nursing/Home health aid services are limited to 24 units a day.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X436","Procedure code on historical claim indicates that multiple services were performed. This line should be reviewed for potential multiple procedure reductions.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X437","The first 10 miles of the trip are not payable for CAS and NAS providers.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X438","Taxi is not reimbursed for mileage","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X439","Time units limited to 6 units when modifier AD is billed.","","","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X44","INSTITUTIONAL CLAIM WAS REGROUPED BASED ON POLICY. FINAL DRG WAS CHANGED .","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X440","Statutory Adjustment. Payment reduced to of fee payment.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X441","Assistant Surgeon modifier indicates the line is reimbursed at 16% of the physician fee schedule.","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X442","The presence of modifier 54 indicates that only the Surgical care portion of the global fee should be reimbursed at 70%","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X443","The presence of modifier 55 indicates that only Post-operative portion of the global fee should be reimbursed at 20%","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X444","The presence of modifier 56 indicates that only Pre-operative portion of the global fee should be reimbursed at 10%","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X445","Physician filing for a mid-level provider.  Services reimbursed at 92% of fee schedule.","","","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X446","Taxonomy reimburses at a variable percentage of the physician fee schedule.","","","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X447","CRNA service modifier indicates the line is reimbursed at 92% of the physician fee schedule.","","","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["Y448","(Physician/Ancillary)Per Medicaid's Medically Unlikely Edits Policy, total units billed for procedure exceed the allowed units.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X448","(Physician/Ancillary)Per Medicaid''s Medically Unlikely Edits Policy, total units billed for procedure exceed the allowed units.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X449","(Outpatient)Per Medicaid''s Medically Unlikely Edits Policy, total units billed for procedure exceed the allowed units.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y449","(Outpatient)Per Medicaid's Medically Unlikely Edits Policy, total units billed for procedure exceed the allowed units.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X45","INVALID DIAGNOSIS CODE","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X450","(Physician/Ancillary)Per Medicaid''s CCI Guidelines, Procedure Code has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["Y450","Physician/Ancillary)Per Medicaid's CCI Guidelines, Procedure Code has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["Y451","(Physician/Ancillary)Per Medicaid's CCI Guidelines, History Procedure Code on Claim has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X451","(Physician/Ancillary)Per Medicaid's CCI Guidelines, History Procedure Code on Claim has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X452","(Outpatient)Per Medicaid's CCI Guidelines, Procedure Code has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["Y452","(Outpatient)Per Medicaid's CCI Guidelines, Procedure Code has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["Y453","(Outpatient)Per Medicaid's CCI Guidelines, History Procedure Code has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X453","(Outpatient)Per Medicaid's CCI Guidelines, History Procedure Code has an unbundle relationship with another procedure code billed.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["X454","LATE BILLS ARE NOT COVERED","N214","Missing/incomplete/invalid history of the related initial surgical procedure(s).","CO","Contractual Obligations","B4","Late filing penalty."]
["Y455","IL MCD emergency contraceptive pills must be billed using J8499 effective with dates of service June 1, 2016 and after.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X455","IL MCD emergency contraceptive pills must be billed using J8499 effective with dates of service June 1, 2016 and after.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X456","FQHC MUST BILL WITH ENCOUNTER CODE T1015","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","B15","This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y456","Service is not payable under the FQHC encounter rate.","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X457","Type of Bill 13x is invalid for Critical Access Hospital outpatient services.  Please rebill using Type of Bill 85x.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X46","DIAGNOSIS AND AGE CONFLICT","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X468","NDC billed is not in the proper format.  The NDC must be in the 5-4-2 configuration. (line level denial)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y468","NDC billed is not in the proper format.  The NDC must be in the 5-4-2 configuration. (line level denial)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y469","NDC billed is not in the proper format.  The NDC must be in the 5-4-2 configuration. (claim level denial)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X469","NDC billed is not in the proper format.  The NDC must be in the 5-4-2 configuration. (claim level denial)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X47","DIAGNOSIS AND SEX CONFLICT","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","10","The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X471","Procedure code requires that an NDC must be billed according to NDC billing guidelines. (claim level denial)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y471","Procedure code requires that an NDC must be billed according to NDC billing guidelines. (claim level denial)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y472","S5190 is for reporting purposes only and is not payable.","","","CO","Contractual Obligations","246","This non-payable code is for required reporting only."]
["X472","S5190 is for reporting purposes only and is not payable.","","","CO","Contractual Obligations","246","This non-payable code is for required reporting only."]
["X473","RENDERING NPI IS NOT VALID FOR THIS ENCOUNTER.","N570","Missing/incomplete/invalid credentialing data.","CO","Contractual Obligations","185","The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y474","Place of service is illogical.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X474","Place of service is illogical.","","","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X475","Long Acting Reversible Contraception (LARC) must be billed separately from the encounter.","N61","Rebill services on separate claims.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y475","Long Acting Reversible Contraception (LARC) must be billed separately from the encounter.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X48","MEDICARE SECONDARY PAYER ALERT","MA64","Our 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.","CO","Contractual Obligations","22","This care may be covered by another payer per coordination of benefits."]
["X49","E-DIAGNOSIS CODE CAN NOT BE USED AS PRINCIPAL DIAGNOSIS","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y499","INSTITUTIONAL CLAIM WAS REGROUPED BASED ON POLICY. FINAL APR-DRG WAS CHANGED.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X499","INSTITUTIONAL CLAIM WAS REGROUPED BASED ON POLICY. FINAL APR-DRG WAS CHANGED.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X5","THE PATIENT SEX IS INVALID","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y5","THE PATIENT SEX IS INVALID","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X50","INVALID PROCEDURE CODE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X500","DIAGNOSTIC/THERAPEUTIC IMAGING RADIOPHARMACEUTICAL / CONTRAST AGENT LINK IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE IMAGING PROCEDURE","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y500","DIAGNOSTIC/THERAPEUTIC IMAGING RADIOPHARMACEUTICAL / CONTRAST AGENT LINK IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE IMAGING PROCEDURE","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X507","DRUG QUANTITY DISPENSED OR QUANTITY BILLED INFORMATION IS MISSING OR INVALID.","M123","Missing/incomplete/invalid name, strength, or dosage of the drug furnished.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X508","Drug unit qualifier (unit of measure) is missing or invalid","N816","Missing/Incomplete/Invalid NDC Unit of Measure","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y508","Drug unit qualifier (unit of measure) is missing or invalid","M123","Missing/incomplete/invalid name, strength, or dosage of the drug furnished.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X51","PROCEDURE AND AGE CONFLICT (INACTIVE)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X517","Possible improper billing of Accute Kidney Injury claim (Eff. 1/1/2017)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y517","Possible improper billing of Accute Kidney Injury claim (Eff. 1/1/2017)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y518","Revenue code is no longer valid for this service, please rebill with correct H code.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X518","Revenue code is no longer valid for this service, please rebill with correct H code.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X519","Place of service is missing or not valid.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y519","Place of service is missing or not valid.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X52","THE PROCEDURE PREFORMED AND THE PATIENT SEX CONFLICT","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X520","Procedure code must be billed with Place of Service 55.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y520","Procedure code must be billed with Place of Service 55.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y521","Series Bill Revenue Code Required","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X521","SERIES BILL REVENUE CODE REQUIRED","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X522","PER MEDICAID GUIDELINES, THIS PROCEDURE QUALIFIES FOR A MULTIPLE ENDOSCOPY REDUCTION AND PAYMENT SHOULD BE REDUCED BY THE VALUE OF BASE ENDOSCOPY CODE","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["X53","NON-COVERED UNDER ANY MEDICARE OUTPATIENT BENEFIT, FOR REASONS OTHER THAN STATUTORY EXCLUSION","N174","This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y539","Inpatient Principal Hospital Acquired Condition","","","CO","Contractual Obligations","233","Services/charges related to the treatment of a hospital-acquired condition or preventable medical error."]
["X539","Inpatient Principal Hospital Acquired Condition","","","CO","Contractual Obligations","233","Services/charges related to the treatment of a hospital-acquired condition or preventable medical error."]
["X54","SERVICE SUBMITTED FOR DENIAL (CONDITION CODE 21)","M44","Missing/incomplete/invalid condition code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y540","Inpatient Other Hospital Acquired Condition","","","CO","Contractual Obligations","233","Services/charges related to the treatment of a hospital-acquired condition or preventable medical error."]
["X540","INPATIENT OTHER HOSPITAL ACQUIRED CONDITION","","","CO","Contractual Obligations","233","Services/charges related to the treatment of a hospital-acquired condition or preventable medical error."]
["Y546","THIS LINE ITEM CONFLICTS WITH CCI EDIT POLICY.","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X546","THIS LINE ITEM CONFLICTS WITH CCI EDIT POLICY.","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X547","DME CODE BILLED WITH INVALID MODIFIER.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y547","DME CODE BILLED WITH INVALID MODIFIER.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y548","PAYMENT FOR DISCONTINUED PROCEDURES IS BASED ON PERCENTAGE OF SERVICE COMPLETED.  PLEASE SUBMIT MEDICAL RECORDS.","N204","Services under review for possible pre-existing condition. Send medical records for prior 12 months","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["X548","PAYMENT FOR DISCONTINUED PROCEDURES IS BASED ON PERCENTAGE OF SERVICE COMPLETED.  PLEASE SUBMIT MEDICAL RECORDS.","N204","Services under review for possible pre-existing condition. Send medical records for prior 12 months","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["X549","AB CODE IS PART OF AN AUTOMATED PANEL.  REIMBURSEMENT IS A PERCENTAGE OF MPFS ALLOWABLE.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["Y549","AB CODE IS PART OF AN AUTOMATED PANEL.  REIMBURSEMENT IS A PERCENTAGE OF MPFS ALLOWABLE.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","144","Incentive adjustment, e.g. preferred product/service."]
["X55","SERVICE SUBMITTED FOR FI/MAC REVIEW (CONDITION CODE 20)","M44","Missing/incomplete/invalid condition code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X550","FX MODIFIER (FILM XRAY) HAS A 20% REDUCTION OF THE TC (AND THE TC OF THE GLOABEL FEE) EFFECTIVE 1/1/17.","N546","Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y550","FX MODIFIER (FILM XRAY) HAS A 20% REDUCTION OF THE TC (AND THE TC OF THE GLOABEL FEE) EFFECTIVE 1/1/17.","N546","Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y551","THIS IS A DUPLICATE LINE ITEM","N111","No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X551","THIS IS A DUPLICATE LINE ITEM","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X552","SUPPLIES FURNISHED BY COMPREHENSIVE OUTPATIENT REHABILITATION FACILITIES (CORFS) OR OUTPATIENT PHYSICAL THERAPY PROVIDERS (OPTS) ARE CONSIDERED PART OF THE PRACTICE EXPENSE AND ARE INCLUDED IN THE CALULATION OF THE RELATIVE VALUES UNDER THE MPFS. SUPPLIES AND DEVICES NOT SEPARATELY PAYABLE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y552","SUPPLIES FURNISHED BY COMPREHENSIVE OUTPATIENT REHABILITATION FACILITIES (CORFS) OR OUTPATIENT PHYSICAL THERAPY PROVIDERS (OPTS) ARE CONSIDERED PART OF THE PRACTICE EXPENSE AND ARE INCLUDED IN THE CALULATION OF THE RELATIVE VALUES UNDER THE MPFS. SUPPLIES AND DEVICES NOT SEPARATELY PAYABLE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y553","(CERCLAGE REMOVAL) WILL BE DENIED AS INCLUDED IN THE DELIVERY FEE, WHEN THE REMOVAL OF A CERCLAGE IS BILLED ON THE SAME DATE OF SERVICE AS THE DELIVERY CODE.","N55","Procedures for billing with group/referring/performing providers were not followed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X553","(CERCLAGE REMOVAL) WILL BE DENIED AS INCLUDED IN THE DELIVERY FEE, WHEN THE REMOVAL OF A CERCLAGE IS BILLED ON THE SAME DATE OF SERVICE AS THE DELIVERY CODE.","N55","Procedures for billing with group/referring/performing providers were not followed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X554","PROCEDURE CODE REQUIRES ICD-10 Z00.6 ALSO BE BILLED ON THE CLAIM.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y554","PROCEDURE CODE REQUIRES ICD-10 Z00.6 ALSO BE BILLED ON THE CLAIM.","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y555","DME CODE BILLED WITH MODIFIER WILL BE DENIED BECAUSE SAME EQUIPMENT HAS BEEN PURCHASED WITHIN PAST 5 YEARS ON CLAIM.","N417","This service is allowed 1 time in a 5-year period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["X555","DME CODE BILLED WITH MODIFIER WILL BE DENIED BECAUSE SAME EQUIPMENT HAS BEEN PURCHASED WITHIN PAST 5 YEARS ON CLAIM.","N417","This service is allowed 1 time in a 5-year period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["X556","(STERILE SALINE) BILLED WITH ORORPHARYNGEAL SUCTION CATHETER WHEN A TRACHEAL SUCTION CATHETER HAS NOT BEEN BILLED IN THE SAME MONTH WILL BE DENIED.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","169","Alternate benefit has been provided."]
["Y556","(STERILE SALINE) BILLED WITH ORORPHARYNGEAL SUCTION CATHETER WHEN A TRACHEAL SUCTION CATHETER HAS NOT BEEN BILLED IN THE SAME MONTH WILL BE DENIED.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y557","(MASTECTOMY BRA) WILL BE DENIED IF BREAST PROSTHESIS HAS NOT BEEN BILLED WITHIN THE PREVIOUS TWO (2) YEARS.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X557","(MASTECTOMY BRA) WILL BE DENIED IF BREAST PROSTHESIS HAS NOT BEEN BILLED WITHIN THE PREVIOUS TWO (2) YEARS.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X558","() IS DENIED BECAUSE THE SAME PROCEDURE HAS BEEN RENDERED TO THE MEMBER ON WITHIN THE PREVIOUS FIVE YEARS ON CLAIM #.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y558","() IS DENIED BECAUSE THE SAME PROCEDURE HAS BEEN RENDERED TO THE MEMBER ON WITHIN THE PREVIOUS FIVE YEARS ON CLAIM #.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y559","(DME REPAIR) IS DENIED BECAUSE THE MEMBER HAS DURABLE MEDICAL EQUIPMENT PURCHASE ON THE SAME SERVICE DATE AS DME REPAIR ON CLAIM #.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X559","(DME REPAIR) IS DENIED BECAUSE THE MEMBER HAS DURABLE MEDICAL EQUIPMENT PURCHASE ON THE SAME SERVICE DATE AS DME REPAIR ON CLAIM #.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X56","QUESTIONABLE COVERED SERVICE","N661","Documentation does not support that the services rendered were medically necessary.","OA","OA Other adjustments","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y560","(DME REPAIR) IS DENIED BECAUSE IT WAS BILLED WITH A FREQUENTLY SERVICED RENTAL ITEM APPENDED WITH MODIFIER -RR.","MA114","Missing/incomplete/invalid information on where the services were furnished.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X560","(DME REPAIR) IS DENIED BECAUSE IT WAS BILLED WITH A FREQUENTLY SERVICED RENTAL ITEM APPENDED WITH MODIFIER -RR.","MA114","Missing/incomplete/invalid information on where the services were furnished.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X561","(POWER WHEELCHAIR ACCESSORY) IS DENIED BECAUSE POWER WHEELCHAIR WAS NOT FOUND IN CLAIM HISTORY WITH THE SAME DATE OF SERVICE {1:MM/DD/YYYY}.","MA114","Missing/incomplete/invalid information on where the services were furnished.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y561","(POWER WHEELCHAIR ACCESSORY) IS DENIED BECAUSE POWER WHEELCHAIR WAS NOT FOUND IN CLAIM HISTORY WITH THE SAME DATE OF SERVICE {1:MM/DD/YYYY}.","MA114","Missing/incomplete/invalid information on where the services were furnished.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y562","STATIONARY OXYGEN SYSTEM IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE WITHIN THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X562","STATIONARY OXYGEN SYSTEM IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE WITHIN THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X563","PORTABLE OXYGEN SYSTEM IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE WITHIN THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y563","PORTABLE OXYGEN SYSTEM IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE WITHIN THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y564","OXYGEN ACCESSORY IS NOT COVERED BY CMS WHEN BILLED WITH OXYGEN RENTAL SYSTEM ON THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X564","OXYGEN ACCESSORY IS NOT COVERED BY CMS WHEN BILLED WITH OXYGEN RENTAL SYSTEM ON THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X565","STATIONARY OXYGEN CONTENTS IS NOT COVERED BY CMS WHEN BILLED WITH STATIONARY OXYGEN RENTAL SYSTEM ON THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y565","STATIONARY OXYGEN CONTENTS IS NOT COVERED BY CMS WHEN BILLED WITH STATIONARY OXYGEN RENTAL SYSTEM ON THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y566","NEBULIZER IS NOT COVERED IF BILLED MORE THAN ONCE EVERY MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X566","NEBULIZER IS NOT COVERED IF BILLED MORE THAN ONCE EVERY MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X567","RESPIRATORY ASSIST DEVICE IS NOT COVERED IF BILLED MORE THAN ONCE EVERY MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y567","RESPIRATORY ASSIST DEVICE IS NOT COVERED IF BILLED MORE THAN ONCE EVERY MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y568","TENS DEVICE IS NOT COVERED BY CMS AS A PURCHASE IF IT HAS NOT BEEN BILLED WITH A RENTAL MODIFIER (RR) IN THE PAST 60 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X568","TENS DEVICE IS NOT COVERED BY CMS AS A PURCHASE IF IT HAS NOT BEEN BILLED WITH A RENTAL MODIFIER (RR) IN THE PAST 60 DAYS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X569","TENS SUPPLIES ARE NOT COVERED BY CMS BECASE A TENS DEVICE WAS BILLED ON ANOTHER CLAIM.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y569","TENS SUPPLIES ARE NOT COVERED BY CMS BECASE A TENS DEVICE WAS BILLED ON ANOTHER CLAIM.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X57","SEPARATE PAYMENT FOR SERVICES IS NOT PROVIDED BY MEDICARE","","","CO","Contractual Obligations","242","Services not provided by network/primary care providers."]
["X570","TENS SUPPLIES ARE NOT COVERED BY CMS BECAUSE \"A4595\" WAS BILLED ON ANOTHER CLAIM.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y570","TENS SUPPLIES ARE NOT COVERED BY CMS BECAUSE \"A4595\" WAS BILLED ON ANOTHER CLAIM.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y571","REPLACEMENT LEAD WIRES ARE NOT COVERED BY CMS BECAUSE A TENS DEVICE WAS BILLED ON ANOTHER CLAIM.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X571","REPLACEMENT LEAD WIRES ARE NOT COVERED BY CMS BECAUSE A TENS DEVICE WAS BILLED ON ANOTHER CLAIM.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X572","PRESSURE REDUCING SUPPORT SURFACE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE WITHIN THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y572","PRESSURE REDUCING SUPPORT SURFACE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE WITHIN THE SAME MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y573","ORTHOSES ADDITION CODES ARE NOT ELIGIBLE FOR SEPARATE PAYMENT.","N15","Services for a newborn must be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X573","ORTHOSES ADDITION CODES ARE NOT ELIGIBLE FOR SEPARATE PAYMENT.","N15","Services for a newborn must be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X574","ORTHOSES ADDITION CODES ARE INCLUDED IN PRIMARY PROCEDURE.","M75","Multiple automated multichannel tests performed on the same day combined for payment.","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["Y574","ORTHOSES ADDITION CODES ARE INCLUDED IN PRIMARY PROCEDURE.","M75","Multiple automated multichannel tests performed on the same day combined for payment.","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["Y575","E/M PROCEDURE WAS BILLED ON THE SAME DATE OF SERVICE WITH CARDIOVASCUALR SERVICE WITHOUT AN APPROPRIATE MODIFIER","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X575","E/M PROCEDURE WAS BILLED ON THE SAME DATE OF SERVICE WITH CARDIOVASCUALR SERVICE WITHOUT AN APPROPRIATE MODIFIER","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X576","E/M PROCEDURE WAS BILLED ON THE SAME DATE OF SERVICE WITH CARDIOVASCUALR SERVICE ON HISTORY CLAIM , EXT/LNT LINE ID WITHOUT AN APPROPRIATE MODIFIER","N13","Payment based on professional/technical component modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y576","E/M PROCEDURE WAS BILLED ON THE SAME DATE OF SERVICE WITH CARDIOVASCUALR SERVICE ON HISTORY CLAIM , EXT/LNT LINE ID WITHOUT AN APPROPRIATE MODIFIER","N13","Payment based on professional/technical component modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y577","VERTEBRAL AXIAL DECOMPRESSION, PER SESSION, IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X577","VERTEBRAL AXIAL DECOMPRESSION, PER SESSION, IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X578","HAIR ANALYSIS IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y578","HAIR ANALYSIS IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y579","BACTERIAL URINE CULTURE IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X579","BACTERIAL URINE CULTURE IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X58","CODE INDICATES A SITE OF SERVICE NOT INCLUDED IN OPPS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y580","HUMAN IMUNODEFICIENCY VIRUS (HIV) TESTING IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X580","HUMAN IMUNODEFICIENCY VIRUS (HIV) TESTING IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X581","HUMAN IMMUNODEFICIENCY VIRUS (HIV) TESTING (PROGNOSIS INCLUDING MONITORING) IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y581","HUMAN IMMUNODEFICIENCY VIRUS (HIV) TESTING (PROGNOSIS INCLUDING MONITORING) IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y582","BLOOD COUNTS TESTING IS NOT COVERED BY MEDICARE WHEN BILLED WITH UNSUPPORTED DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X582","BLOOD COUNTS TESTING IS NOT COVERED BY MEDICARE WHEN BILLED WITH UNSUPPORTED DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X583","PARTIAL THROMBOPLASTIN TIME (PTT) IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y583","PARTIAL THROMBOPLASTIN TIME (PTT) IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y584","PROTHROMBIN TIME (PT) IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X584","PROTHROMBIN TIME (PT) IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X585","PROCEDURE HAS A MAXIMUM FREQUENCY OF SERVICES","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y585","PROCEDURE HAS A MAXIMUM FREQUENCY OF SERVICES","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y586","PROTHROMBIN TIME (PT) HAS A MAXIMUM FREQUENCY OF SERVICE UNITS PER FREQUENCY VALUE QUALIFIER","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X586","PROTHROMBIN TIME (PT) HAS A MAXIMUM FREQUENCY OF SERVICE UNITS PER FREQUENCY VALUE QUALIFIER","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X587","SERUM IRON STUDIES ARE NOT COVERED BY MEDICARE WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y587","SERUM IRON STUDIES ARE NOT COVERED BY MEDICARE WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y588","SERUM IRON STUDIES ARE NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE IN A 90 DAY INTERVAL.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X588","SERUM IRON STUDIES ARE NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE IN A 90 DAY INTERVAL.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X589","COLLAGEN CROSSLINKS ARE NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y589","COLLAGEN CROSSLINKS ARE NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X59","SERVICE UNIT OUT OF RANGE FOR PROCEDURE (INACTIVE)","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X590","GLYCATED HEMOGLOBIN/GLYCATED PROTEIN ARE NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y590","GLYCATED HEMOGLOBIN/GLYCATED PROTEIN ARE NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y591","THYROID TESTING IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X591","THYROID TESTING IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X592","DIGOXIN THERAPEUTIC DRUG ASSAY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y592","DIGOXIN THERAPEUTIC DRUG ASSAY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y593","ALPHA-FETOPROTEIN IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X593","ALPHA-FETOPROTEIN IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X594","CARCINOEMBRYONIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y594","CARCINOEMBRYONIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y595","TUMOR ANTIGEN BY IMMUNOASSAY CA 125 IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X595","TUMOR ANTIGEN BY IMMUNOASSAY CA 125 IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X596","TUMOR ANTIGEN BY IMMUNOASSAY CA 19-9 IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y596","TUMOR ANTIGEN BY IMMUNOASSAY CA 19-9 IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y597","PROSTATE SPECIFIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X597","PROSTATE SPECIFIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X598","PROSTATE SPECIFIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE IN A 12 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y598","PROSTATE SPECIFIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE IN A 12 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y599","GAMMA GLUTAMYL TRANSFERASE IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X599","GAMMA GLUTAMYL TRANSFERASE IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["X6","ADMISSION DIAGNOSIS DESCRIBES AN EXTERNAL CAUSE OR REQUIRES THE ICD CODE FOR THE FIRST UNDERLYING DISEASE AND SHOULD NEVER BE USED AS THE FIRST DIAGNOSIS FOR A PROCEDURE","MA65","Missing/incomplete/invalid admitting diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y6","ADMISSION DIAGNOSIS DESCRIBES AN EXTERNAL CAUSE OR REQUIRES THE ICD CODE FOR THE FIRST UNDERLYING DISEASE AND SHOULD NEVER BE USED AS THE FIRST DIAGNOSIS FOR A PROCEDURE","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X60","MULTIPLE BILATERAL PROCEDURES WITHOUT MODIFIER 50","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X600","HEPATITIS PANEL/ACUTE HEPATITIS PANEL IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y600","HEPATITIS PANEL/ACUTE HEPATITIS PANEL IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE SUPPORTING DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y601","ALUMINUM LAB TEST IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE WITHIN A 3 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X601","ALUMINUM LAB TEST IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE WITHIN A 3 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X602","HEARTSBREATH TEST IS NOT REASONABLE AND NECESSARY AND IS NOT COVERED BY CMS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y602","HEARTSBREATH TEST IS NOT REASONABLE AND NECESSARY AND IS NOT COVERED BY CMS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y603","BRACHYTHERAPY SOURCES PROCEDURE REQUIRES A VALID BRACHYTHERAPY PROCEDURE.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X603","BRACHYTHERAPY SOURCES PROCEDURE REQUIRES A VALID BRACHYTHERAPY PROCEDURE.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X604","DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE WHEN BILLED WITH CRITICAL CARE, EVALUATION AND MANAGEMENT FOR THE SAME DATE OF SERVICE WILL BE DENIED.","N55","Procedures for billing with group/referring/performing providers were not followed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y604","DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE WHEN BILLED WITH CRITICAL CARE, EVALUATION AND MANAGEMENT FOR THE SAME DATE OF SERVICE WILL BE DENIED.","N55","Procedures for billing with group/referring/performing providers were not followed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y605","DMEPOS ITEMS BILLED BY A DMEMAC PROVIDER WITH INVALID POS WILL BE DENIED.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X605","DMEPOS ITEMS BILLED BY A DMEMAC PROVIDER WITH INVALID POS WILL BE DENIED.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X606","MANUAL WHEELCHAIR OR WHEELCHAIR-SPECIAL SIZE MUST BE BILLED WITH MODIFIER KX","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y606","MANUAL WHEELCHAIR OR WHEELCHAIR-SPECIAL SIZE MUST BE BILLED WITH MODIFIER KX","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y607","GLYCATED HEMOGLOBIN/GLYCATED PROTEIN PROCEDURE IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE WITHIN A 90 DAY PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X607","GLYCATED HEMOGLOBIN/GLYCATED PROTEIN PROCEDURE IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE WITHIN A 90 DAY PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X608","CARCINOEMBRYONIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN TWICE WITHIN A PATIENT'S LIFETIME","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y608","CARCINOEMBRYONIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN TWICE WITHIN A PATIENT'S LIFETIME","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y609","A4606 (RE-USABLE PULSE OXIMETER) WITH MODIFIER U5 - 1 UNIT EVERY SIX CALENDAR MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X609","A4606 (RE-USABLE PULSE OXIMETER) WITH MODIFIER U5 - 1 UNIT EVERY SIX CALENDAR MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X61","INAPPROPRIATE SPECIFICATION OF BILATERAL PROCEDURE","M67","Missing/incomplete/invalid other procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y610","A4606 (RE-USABLE PULSE OXIMETER) WITH NO MODIFIER - 4 PER MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X610","A4606 (RE-USABLE PULSE OXIMETER) WITH NO MODIFIER - 4 PER MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X611","A4623 (TRACHEOSTOMY, DISPOSABLE INNER CANNULA) WITH MODIFIER U3 - 31 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y611","A4623 (TRACHEOSTOMY, DISPOSABLE INNER CANNULA) WITH MODIFIER U3 - 31 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y612","A4623 (TRACHEOSTOMY, DISPOSABLE INNER CANNULA) WITH NO MODIFIER - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X612","A4623 (TRACHEOSTOMY, DISPOSABLE INNER CANNULA) WITH NO MODIFIER - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X613","A7520 â\u0080\u0093 1 UNIT PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y613","A7520 â\u0080\u0093 1 UNIT PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y614","A7520 WITH MODIFIER U1 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X614","A7520 WITH MODIFIER U1 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X615","A7520 WITH MODIFIER U2 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y615","A7520 WITH MODIFIER U2 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y616","A7521 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X616","A7521 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X617","A7521 WITH MODIFIER U1 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y617","A7521 WITH MODIFIER U1 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y618","A7521 WITH MODIFIER U2 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X618","A7521 WITH MODIFIER U2 - 1 PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X619","E0445 (OXIMETER DEVICE) WITH MODIFIER U4 - 1 PER FIVE ROLLING YEARS","N460","Incomplete/invalid Discharge Summary.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y619","E0445 (OXIMETER DEVICE) WITH MODIFIER U4 - 1 PER FIVE ROLLING YEARS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X62","INPATIENT PROCEDURE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y620","E0445 WITH NO MODIFIER - 1 EVERY 6 MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X620","E0445 WITH NO MODIFIER - 1 EVERY 6 MONTHS","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X621","IT IS INAPPROPRIATE TO PROVIDE HEPATITIS A/B VACCINES, INFLUENZA VACCINES OR PNEUMOCOCCAL PNEUMONIA VACCINES, AND THEIR ADMINISTRATION IN A CORF.","N428","Not covered when performed in this place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y621","IT IS INAPPROPRIATE TO PROVIDE HEPATITIS A/B VACCINES, INFLUENZA VACCINES OR PNEUMOCOCCAL PNEUMONIA VACCINES, AND THEIR ADMINISTRATION IN A CORF.","N428","Not covered when performed in this place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y622","A COMBINATION OF MODIFIERS GN, GO, OR GP CANNOT BE REPORTED ON THE SAME SERVICE LINE ON INSTITUTIONAL CLAIMS.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X622","A COMBINATION OF MODIFIERS GN, GO, OR GP CANNOT BE REPORTED ON THE SAME SERVICE LINE ON INSTITUTIONAL CLAIMS.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X623","THERAPY SERVICES MUST BE BILLED WITH A MODIFIER APPROPRIATE TO THE REVENUE CODE.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y623","THERAPY SERVICES MUST BE BILLED WITH A MODIFIER APPROPRIATE TO THE REVENUE CODE.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y624","ACCORDING TO CMS POLICY, PROCEDURES THAT ARE REDUCED SERVICES (MODIFIER 52) OR DISCONTINUED PRIOR TO ADMINISTRATION OF ANESTHESIA (MODIFIER 73) MAY NOT BE BILLED WITH UNITS GREATER THAN ONE.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X624","ACCORDING TO CMS POLICY, PROCEDURES THAT ARE REDUCED SERVICES (MODIFIER 52) OR DISCONTINUED PRIOR TO ADMINISTRATION OF ANESTHESIA (MODIFIER 73) MAY NOT BE BILLED WITH UNITS GREATER THAN ONE.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X625","MODIFIER Q0 OR MODIFIER Q1 CAN ONLY BE BILLED WHEN CONDITION CODE 30 AND BILL TYPE 0130-013Z (HOSPITAL-OUTPATIENT) ARE ALSO PRESENT ON THE CLAIM.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y625","MODIFIER Q0 OR MODIFIER Q1 CAN ONLY BE BILLED WHEN CONDITION CODE 30 AND BILL TYPE 0130-013Z (HOSPITAL-OUTPATIENT) ARE ALSO PRESENT ON THE CLAIM.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y626","BRACHYTHERAPY SOURCE BILLED WITHOUT AN APPROVED ASC SURGICAL PROCEDURE.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X626","BRACHYTHERAPY SOURCE BILLED WITHOUT AN APPROVED ASC SURGICAL PROCEDURE.","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X627","CONDITION CODE 44 (INPATIENT ADMISSION CHANGED TO OUTPATIENT) CAN ONLY BE BILLED WITH BILL TYPES 0130-013Z (HOSPITAL OUTPATIENT) OR 0850-085Z (CRITICAL ACCESS HOSPITAL).","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y627","CONDITION CODE 44 (INPATIENT ADMISSION CHANGED TO OUTPATIENT) CAN ONLY BE BILLED WITH BILL TYPES 0130-013Z (HOSPITAL OUTPATIENT) OR 0850-085Z (CRITICAL ACCESS HOSPITAL).","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y628","PER THE MEDICARE PHYSICIAN FEE SCHEDULE, PROCEDURE CODE DESCRIBES A PHYSICAL THERAPY SERVICES SUBMITTED WITH AN INAPPROPRIATE PLACE OF SERVICE. MUST BE IN OFFICE OR HOME.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X628","PER THE MEDICARE PHYSICIAN FEE SCHEDULE, PROCEDURE CODE DESCRIBES A PHYSICAL THERAPY SERVICES SUBMITTED WITH AN INAPPROPRIATE PLACE OF SERVICE. MUST BE IN OFFICE OR HOME.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X629","MODIFIER ON PROC CODE INDICATES A REDUCTION.","N546","Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y629","MODIFIER ON PROC CODE INDICATES A REDUCTION.","N546","Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X63","MUTUALLY EXCLUSIVE PROCEDURE THAT IS NOT ALLOWED BY NCCI EVEN IF APPROPRIATE MODIFIER IS PRESENT","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X630","PER CMS POLICY, PROCEDURE CODE DESCRIBES HYPERTHERMIA SERVICES WHICH ARE ONLY COVERED WHEN BILLED IN CONJUNCTION WITH RADIATION THERAPY TREATMENTS .","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y630","PER CMS POLICY, PROCEDURE CODE DESCRIBES HYPERTHERMIA SERVICES WHICH ARE ONLY COVERED WHEN BILLED IN CONJUNCTION WITH RADIATION THERAPY TREATMENTS .","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y631","(HOSPITAL DISCHARGE SERVICES) WAS BILLED ON PRIOR DAY ON CLAIM.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X631","(HOSPITAL DISCHARGE SERVICES) WAS BILLED ON PRIOR DAY ON CLAIM.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X632","CO-SURGEONS COULD BE PAID, THOUGH SUPPORTING DOCUMENTATION IS REQUIRED TO ESTABLISH THE MEDICAL NECESSITY OF TWO SURGEONS FOR THE PROCEDURE.","N706","Missing documentation.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["Y632","CO-SURGEONS COULD BE PAID, THOUGH SUPPORTING DOCUMENTATION IS REQUIRED TO ESTABLISH THE MEDICAL NECESSITY OF TWO SURGEONS FOR THE PROCEDURE.","N706","Missing documentation.","CO","Contractual Obligations","163","Attachment/other documentation referenced on the claim was not received."]
["Y633","PER THE MEDICARE PHYSICIAN FEE SCHEDULE, PROCEDURE CODE DESCRIBES A PHYSICIAN INTERPRETATION FOR SERVICE AND CAN NOT BE BILLED WITH MODIFIER TC OR IN A PLACE OF SERVICE OTHER THAN INPATIENT.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X633","PER THE MEDICARE PHYSICIAN FEE SCHEDULE, PROCEDURE CODE DESCRIBES A PHYSICIAN INTERPRETATION FOR SERVICE AND CAN NOT BE BILLED WITH MODIFIER TC OR IN A PLACE OF SERVICE OTHER THAN INPATIENT.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X634","PER CMS GUIDELINES, CO-SURGEON CLAIMS WHEN BOTH SURGEONS HAVE THE SAME SUBSPECIALTY FOR PROCEDURES DESIGNATED AS \"CO-SURGEONS ALLOWED\" WILL BE DENIED. HISTORICAL CLAIM ({0}) BILLED BY NPI {1}","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y634","PER CMS GUIDELINES, CO-SURGEON CLAIMS WHEN BOTH SURGEONS HAVE THE SAME SUBSPECIALTY FOR PROCEDURES DESIGNATED AS \"CO-SURGEONS ALLOWED\" WILL BE DENIED. HISTORICAL CLAIM ({0}) BILLED BY NPI {1}","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","204","This service/equipment/drug is not covered under the patient's current benefit plan"]
["Y635","PER AMA GUIDELINES, INITIAL HOSPITAL OR BIRTHING CENTER CARE WILL BE DENIED WHEN THE NEWBORN HAS RECEIVED NEWBORN CARE SERVICES THE PREVIOUS DAY. HISTORICAL CLAIM: {1}","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X635","PER AMA GUIDELINES, INITIAL HOSPITAL OR BIRTHING CENTER CARE WILL BE DENIED WHEN THE NEWBORN HAS RECEIVED NEWBORN CARE SERVICES THE PREVIOUS DAY. HISTORICAL CLAIM: {1}","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y636","ROOM & BOARD REVENUE CODES IN AN OUTPATIENT HOSPITAL SETTING","N676","Service does not qualify for payment under the Outpatient Facility Fee Schedule.","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["Y637","DROP VCE.49953 (040CCO - MODIFIER 59)","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y638","DROP VCE.49953 (040CCO COPY - MODIFIER TC)","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y639","DROP VCE.21210 (PATIENT AGE GREATER THAN 70)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X64","CODE2 OF A CODE PAIR THAT IS NOT ALLOWED BY NCCI EVEN IF APPROPRIATE MODIFIER IS PRESENT","","","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["Y640","DROP VCE.20603 (NPT - EXCLUDE PREVENTATIVE CODES)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y641","DROP VCE.21205 (SUB 90680 - ADMIN CODES)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y642","INSTITUTIONAL CLAIM IS A POSSIBLE DUPLICATE OF CLAIM .","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y643","PROCEDURE CODE IS A POSSIBLE DUPLICATE OF CLAIM LINE. PROCEDURE SHOULD BE BILLED IN THE SAME SERVICE SECTION.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y644","PROCEDURE LINE IS A POSSIBLE DUPLICATE OF CLAIM. PROCEDURE CAN NOT BE BILLED ON SAME DOS WITH DIFFERING MODIFIERS.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X644","PROCEDURE LINE IS A POSSIBLE DUPLICATE OF CLAIM. PROCEDURE CAN NOT BE BILLED ON SAME DOS WITH DIFFERING MODIFIERS.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X645","INJECTIONS, LABS REPORTS, AND TESTS MUST BE BILLED WITH SPECIFIC PROCEDURE CODE ON ONE SERVICE SECTION.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y645","INJECTIONS, LABS REPORTS, AND TESTS MUST BE BILLED WITH SPECIFIC PROCEDURE CODE ON ONE SERVICE SECTION.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y646","THERAPY MUST BE BILLED WITH ONE SERVICE SECTION FOR EACH ITEM (PT, OT OR ST) OR SERVICE PROVIDED TO THE PATIENT ALONG WITH THE RIGHT MODIFIERS GP, GO OR GN, IF BILLING MULTIPLES.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X646","THERAPY MUST BE BILLED WITH ONE SERVICE SECTION FOR EACH ITEM (PT, OT OR ST) OR SERVICE PROVIDED TO THE PATIENT ALONG WITH THE RIGHT MODIFIERS GP, GO OR GN, IF BILLING MULTIPLES.","N381","Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X647","MODIFIER 25/59 CAN NOT BE BILLED MULTIPLE TIMES FOR THE SAME SERVICE RENDERED ON THE SAME DOS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y647","MODIFIER 25/59 CAN NOT BE BILLED MULTIPLE TIMES FOR THE SAME SERVICE RENDERED ON THE SAME DOS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y648","PRICING MODIFIERS SHOULD NOT BE SUBMITTED MULTIPLE TIMES ON THE SAME PROCEDURE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X648","PRICING MODIFIERS SHOULD NOT BE SUBMITTED MULTIPLE TIMES ON THE SAME PROCEDURE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X649","IMPROPER BILLING OF BILATERAL PROCEDURE. UNITS MUST BE 1.","N430","Procedure code is inconsistent with the units billed.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y649","IMPROPER BILLING OF BILATERAL PROCEDURE. UNITS MUST BE 1.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X65","MEDICAL VISIT ON THE SAME DAY AS A TYPE T OR S PROCEDURE WITHOUT MODIFIER 25","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X650","AUDIOLOGY INPATIENT CHARGES ARE INCLUDED IN THE REIMBURSEMENT TO A HOSPITAL AND ARE NOT TO BE BILLED FEE FOR SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y650","AUDIOLOGY INPATIENT CHARGES ARE INCLUDED IN THE REIMBURSEMENT TO A HOSPITAL AND ARE NOT TO BE BILLED FEE FOR SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y651","PROVIDER TAXONOMY CANNOT BILL IN PLACE OF SERVICE .","N288","Missing/incomplete/invalid rendering provider taxonomy.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X651","PROVIDER TAXONOMY CANNOT BILL IN PLACE OF SERVICE .","N288","Missing/incomplete/invalid rendering provider taxonomy.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X652","DME SUPPLIERS CANNOT BILL IN PLACE OF SERVICE WHEN THE PATIENT IS 21 YEARS OR OLDER.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y652","DME SUPPLIERS CANNOT BILL IN PLACE OF SERVICE WHEN THE PATIENT IS 21 YEARS OR OLDER.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y653","REVENUE CODE INVALID FOR CATEGORY OF SERVICE.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X653","REVENUE CODE INVALID FOR CATEGORY OF SERVICE.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X654","OCCURRENCE CODE 50 IS NO LONGER VALID TO BYPASS PA FOR POST-DISCHARGE SERVICES. OCCURRENCE CODE 42 IS NOW REQUIRED.","M45","Missing/incomplete/invalid occurrence code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y654","OCCURRENCE CODE 50 IS NO LONGER VALID TO BYPASS PA FOR POST-DISCHARGE SERVICES. OCCURRENCE CODE 42 IS NOW REQUIRED.","M45","Missing/incomplete/invalid occurrence code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y655","PROCEDCURE CODE CAN ONLY BE USED BY OUTPATIENT FACILITIES BILLED ON AN INSTUTIONAL CLAIM (C CODES)","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X655","PROCEDCURE CODE CAN ONLY BE USED BY OUTPATIENT FACILITIES BILLED ON AN INSTUTIONAL CLAIM (C CODES)","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X656","WHEN MULTIPLE GENERAL ANESTHESIA SERVICE CODES, ONLY THE HIGHEST SUBMITTED CHARGE AMOUNT WILL BE PAID AND THE SECONDARY ANESTHESIA SERVICES SHOULD BE DENIED.","N634","The allowance is calculated based on anesthesia time units.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y656","WHEN MULTIPLE GENERAL ANESTHESIA SERVICE CODES, ONLY THE HIGHEST SUBMITTED CHARGE AMOUNT WILL BE PAID AND THE SECONDARY ANESTHESIA SERVICES SHOULD BE DENIED.","N634","The allowance is calculated based on anesthesia time units.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y657","INCORRECT BILLING OF ASSISTANT SURGEON MODIFIERS FOR CRITICAL ACCESS PROFESSIONAL FEES REVENUE CODE.; REVENUE CODES 0960-0989.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X657","INCORRECT BILLING OF ASSISTANT SURGEON MODIFIERS FOR CRITICAL ACCESS PROFESSIONAL FEES REVENUE CODE.; REVENUE CODES 0960-0989.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X658","INCORRECT BILLING OF CO-SURGEON MODIFIER FOR CRITICAL ACCESS PROFESSIONAL FEES REVENUE CODE.; REVENUE CODES 0960-0989.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y658","INCORRECT BILLING OF CO-SURGEON MODIFIER FOR CRITICAL ACCESS PROFESSIONAL FEES REVENUE CODE.; REVENUE CODES 0960-0989.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y659","C CODES CANNOT BE BILLED WITH REVENUE CODES REPRESENTING PROFESSIONAL FEES; REVENUE CODES 0960-0989.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X659","C CODES CANNOT BE BILLED WITH REVENUE CODES REPRESENTING PROFESSIONAL FEES; REVENUE CODES 0960-0989.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["X66","INVALID MODIFIER","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["Y660","DENY ROOM AND BOARD REVENUE CODES WHEN BILLED IN AN OUTPATIENT HOSPITAL SETTING.","N676","Service does not qualify for payment under the Outpatient Facility Fee Schedule.","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["X660","DENY ROOM AND BOARD REVENUE CODES WHEN BILLED IN AN OUTPATIENT HOSPITAL SETTING.","N676","Service does not qualify for payment under the Outpatient Facility Fee Schedule.","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["X661","MEDICAL/SURGICAL SUPPLIES AND DME CANNOT BE BILLED WITH PROFESSIONAL FEE REVENUE CODES (0960-0989) IN AN OUTPATIENT FACILITY OR INPATIENT FACILITY SETTING.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y661","MEDICAL/SURGICAL SUPPLIES AND DME CANNOT BE BILLED WITH PROFESSIONAL FEE REVENUE CODES (0960-0989) IN AN OUTPATIENT FACILITY OR INPATIENT FACILITY SETTING.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y662","FACILITY SHOULD NOT BILL OP CLAIM.","N676","Service does not qualify for payment under the Outpatient Facility Fee Schedule.","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["X662","FACILITY SHOULD NOT BILL OP CLAIM.","N676","Service does not qualify for payment under the Outpatient Facility Fee Schedule.","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["X663","FACILITY SHOULD NOT BILL IP CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y663","FACILITY SHOULD NOT BILL IP CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","272","Coverage/program guidelines were not met."]
["Y664","PROSTHESIS BILLED WITH MODIFIER K0 OR KO WILL BE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X664","PROSTHESIS BILLED WITH MODIFIER K0 OR KO WILL BE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X665","DME IS NOT ON THE CAPPED RENTAL LIST AND CANNOT BE BILLED WITH A RENTAL MODIFIER","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y665","DME IS NOT ON THE CAPPED RENTAL LIST AND CANNOT BE BILLED WITH A RENTAL MODIFIER","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y666","PROSTHESIS AND ORTHOSIS MUST BE BILLED WITH MODIFIERS LT OR RT","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X666","PROSTHESIS AND ORTHOSIS MUST BE BILLED WITH MODIFIERS LT OR RT","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X667","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER(RR,KI,KH OR KJ)","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y667","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER(RR,KI,KH OR KJ)","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y668","DME SERVICE IS NOT COVERED BY CMS AS A RENTAL OR A PURCHASE WHEN THE ITEM HAS PREVIOUSLY BEEN PAID AS EITHER A RENTAL OR A PURCHASE FOR THE SAME DATE OF SERVICE","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X668","DME SERVICE IS NOT COVERED BY CMS AS A RENTAL OR A PURCHASE WHEN THE ITEM HAS PREVIOUSLY BEEN PAID AS EITHER A RENTAL OR A PURCHASE FOR THE SAME DATE OF SERVICE","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X669","WHEEL CHAIR OR ACCESSORY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y669","WHEEL CHAIR OR ACCESSORY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X67","INVALID DATE","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X670","CUSHIONS AND POSITIONING ACCESSORIES IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y670","CUSHIONS AND POSITIONING ACCESSORIES IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y671","HOSPITAL BED OR ACCESSORY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X671","HOSPITAL BED OR ACCESSORY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X672","TOTAL ELECTRIC HOSPITAL BED IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y672","TOTAL ELECTRIC HOSPITAL BED IS NOT COVERED BY MEDICARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y673","WHEEL CHAIR OR ACCESSORY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X673","WHEEL CHAIR OR ACCESSORY IS NOT COVERED BY MEDICARE WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X674","OXYGEN OR OXYGEN EQUIPMENT IS NOT COVERED WHEN BILLED MORE THAN ONCE PER MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y674","OXYGEN OR OXYGEN EQUIPMENT IS NOT COVERED WHEN BILLED MORE THAN ONCE PER MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y675","OXYGEN RENTAL EQUIPMENT CPT IS NOT COVERED  BY CMS WHEN BILLED WITHOUT RENTAL MODIFIER RR","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X675","OXYGEN RENTAL EQUIPMENT CPT IS NOT COVERED  BY CMS WHEN BILLED WITHOUT RENTAL MODIFIER RR","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X676","LARGE VOLUME ULTRASONIC NEBULIZER/ACCESSORIES ARE NOT COVERED BY CMS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y676","LARGE VOLUME ULTRASONIC NEBULIZER/ACCESSORIES ARE NOT COVERED BY CMS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y677","RESPIRATORY ASSIST DEVICE IS NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X677","RESPIRATORY ASSIST DEVICE IS NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X678","EXTERNAL INFUSION PUMP/ADMINISTRATION IS NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y678","EXTERNAL INFUSION PUMP/ADMINISTRATION IS NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y679","EXTERNAL INFUSION PUMPS ARE NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X679","EXTERNAL INFUSION PUMPS ARE NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X68","DATE OUT OF OCE RANGE","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y680","COMMODE MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X680","COMMODE MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X681","SPEECH GENERATING DEVICE MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y681","SPEECH GENERATING DEVICE MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y682","HIGH FREQUENCY CHEST WALL OSCILLATION DEVICE MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X682","HIGH FREQUENCY CHEST WALL OSCILLATION DEVICE MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X683","AUTOMATIC EXTERNAL DEFIBRILLATOR IS NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y683","AUTOMATIC EXTERNAL DEFIBRILLATOR IS NOT COVERED WHEN BILLED WITHOUT MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y684","MISCELLANEOUS DME SUPPLY/ACCESSORY IS NOT COVERED WHEN BILLED WITH WEARABLE, AUTOMATIC EXTERNAL DEFIBRILLATOR","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X684","MISCELLANEOUS DME SUPPLY/ACCESSORY IS NOT COVERED WHEN BILLED WITH WEARABLE, AUTOMATIC EXTERNAL DEFIBRILLATOR","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X685","HOME GLUCOSE MONITORING SUPPLIES MUST BE BILLED WITH AN APPROPRIATE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y685","HOME GLUCOSE MONITORING SUPPLIES MUST BE BILLED WITH AN APPROPRIATE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y686","SUCTION VALVE BILLED WITH A LOCKING MECHANISM IS NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X686","SUCTION VALVE BILLED WITH A LOCKING MECHANISM IS NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X687","GASTROSTOMY/JEJUNOSTOMY TUBE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE IN A 90 DAY PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y687","GASTROSTOMY/JEJUNOSTOMY TUBE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE IN A 90 DAY PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y688","ENTERAL FEEDING KITS IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X688","ENTERAL FEEDING KITS IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X689","ANKLE-FOOT ORTHOSIS/KNEE-ANKLE-FOOT ORTHOSIS MUST BE BILLED WITH MODIFIER KX.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y689","ANKLE-FOOT ORTHOSIS/KNEE-ANKLE-FOOT ORTHOSIS MUST BE BILLED WITH MODIFIER KX.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X69","PATIENT AGE INVALID","N329","Missing/incomplete/invalid patient birth date.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X690","ORTHOPEDIC FOOTWEAR IS NOT COVERED BY CMS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y690","ORTHOPEDIC FOOTWEAR IS NOT COVERED BY CMS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y691","ORTHOPEDIC SHOES ARE NOT COVERED BY CMS WHEN BILLED WITHOUT A KX MODIFIER","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X691","ORTHOPEDIC SHOES ARE NOT COVERED BY CMS WHEN BILLED WITHOUT A KX MODIFIER","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X692","THERAPEUTIC SHOES/INSERTS/MODIFICATIONS FOR DIABETICS ONLY IS NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE DIAGNOSIS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y692","THERAPEUTIC SHOES/INSERTS/MODIFICATIONS FOR DIABETICS ONLY IS NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE DIAGNOSIS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y693","THERAPEUTIC INSERT FOR DIABETICS ONLY IS NOT COVERED BY CMS WHEN BILLED WITH L5000 ON THE SAME CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X693","THERAPEUTIC INSERT FOR DIABETICS ONLY IS NOT COVERED BY CMS WHEN BILLED WITH L5000 ON THE SAME CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X694","NEGATIVE WOUND THERAPY PRESSURE PUMP MUST BE BILLED WITH MODIFIER KX.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y694","NEGATIVE WOUND THERAPY PRESSURE PUMP MUST BE BILLED WITH MODIFIER KX.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y695","NON-DME CODE BILLED BY A DME PROVIDER WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X695","NON-DME CODE BILLED BY A DME PROVIDER WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X696","PROCEDURE BILLED IN INPATIENT OR FACILITY PLACES OF SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y696","PROCEDURE BILLED IN INPATIENT OR FACILITY PLACES OF SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y697","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE PER MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X697","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE PER MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X698","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE 21 DAY PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y698","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN ONCE 21 DAY PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y699","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN 7 TIMES IN A 13 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X699","CAPPED DME RENTAL IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN 7 TIMES IN A 13 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X7","PRINCIPAL DIAGNOSIS DESCRIBES AN EXTERNAL CAUSE OR REQUIRES THE ICD CODE FOR THE FIRST UNDERLYING DISEASE AND SHOULD NEVER BE USED AS THE FIRST DIAGNOSIS FOR A PROCEDURE","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y7","PRINCIPAL DIAGNOSIS DESCRIBES AN EXTERNAL CAUSE OR REQUIRES THE ICD CODE FOR THE FIRST UNDERLYING DISEASE AND SHOULD NEVER BE USED AS THE FIRST DIAGNOSIS FOR A PROCEDURE","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X70","PATIENT SEX INVALID","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X700","HOSPITAL BED REQUIRES APPROPRIATE CODE WHEN BILLED WITH SIDE RAILS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y700","HOSPITAL BED REQUIRES APPROPRIATE CODE WHEN BILLED WITH SIDE RAILS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y701","KNEE ORTHOSIS AND ORTHOTIC ADDITIONS MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X701","KNEE ORTHOSIS AND ORTHOTIC ADDITIONS MUST BE BILLED WITH MODIFIER KX","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X702","THERAPEUTIC SHOES/INSERTS/MODIFICATIONS FOR DIABETICS ONLY ARE NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX/GY)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y702","THERAPEUTIC SHOES/INSERTS/MODIFICATIONS FOR DIABETICS ONLY ARE NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (KX/GY)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y703","THERAPEUTIC SHOE/INSERT/MODIFICATION FOR DIABETICS ONLY IS NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (RT/LT)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X703","THERAPEUTIC SHOE/INSERT/MODIFICATION FOR DIABETICS ONLY IS NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE MODIFIER (RT/LT)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X704","SURGICAL DRESING MODIFIER CAN CAN ONLY BE BILLED WITH SURGICAL DRESSING CODE","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y704","SURGICAL DRESING MODIFIER CAN CAN ONLY BE BILLED WITH SURGICAL DRESSING CODE","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y705","BASED ON MEDICAID GUIDELINES, A7526 (TRACHEOSTOMY TUBE COLLAR/ HOLDER) IS DENIED WHEN BILLED WITH A4625 OR A4629.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X705","BASED ON MEDICAID GUIDELINES, A7526 (TRACHEOSTOMY TUBE COLLAR/ HOLDER) IS DENIED WHEN BILLED WITH A4625 OR A4629.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X706","INTERMITTENT URINARY CATHETER IS NOT COVERED WHEN BILLED MORE THAN 600 UNITS IN A 3 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y706","INTERMITTENT URINARY CATHETER IS NOT COVERED WHEN BILLED MORE THAN 600 UNITS IN A 3 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y707","UROLOGICAL SUPPLIES ARE NOT COVERED BY CMS WHEN BILLED WITHOUT APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X707","UROLOGICAL SUPPLIES ARE NOT COVERED BY CMS WHEN BILLED WITHOUT APPROPRIATE MODIFIER (KX)","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X708","BLOOD PRODUCT IS A NON-COVERED SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y708","BLOOD PRODUCT IS A NON-COVERED SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y709","PROSTATE SCREENING IS NOT COVERED BY CMS WHEN THE PATIENT IS UNDER 50 YEARS OF AGE.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X709","PROSTATE SCREENING IS NOT COVERED BY CMS WHEN THE PATIENT IS UNDER 50 YEARS OF AGE.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X71","ONLY INCIDENTAL SERVICES REPORTED","N122","Add-on code cannot be billed by itself.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["Y710","SCREENING MAMMOGRAPHY IS NOT COVERED BY CMS WHEN PATIENT'S AGE IS LESS THAN 35","M37","Not covered when the patient is under age 35.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X710","SCREENING MAMMOGRAPHY IS NOT COVERED BY CMS WHEN PATIENT'S AGE IS LESS THAN 35","M37","Not covered when the patient is under age 35.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X711","CPT 55873 (CRYOSURGICAL ABLATION OF THE PROSTATE) MUST BE BILLED WITH DIAGNOSIS C61 (CANCER OF PROSTATE).","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y711","CPT 55873 (CRYOSURGICAL ABLATION OF THE PROSTATE) MUST BE BILLED WITH DIAGNOSIS C61 (CANCER OF PROSTATE).","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y712","SEPARATE REIMBURSEMENT IS NOT ALLOWED FOR RADIOLOGY SERVICES WITH A MODIFIER 26 OR 76140 WHEN BILLED WITH AN E/M SERVICE IN THE OFFICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X712","SEPARATE REIMBURSEMENT IS NOT ALLOWED FOR RADIOLOGY SERVICES WITH A MODIFIER 26 OR 76140 WHEN BILLED WITH AN E/M SERVICE IN THE OFFICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X713","CASTING/STRAPPING PROCEDURE IS NOT COVERED BY CMS WHEN BILLED IN A SKILLED NURSING FACILITY","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y713","CASTING/STRAPPING PROCEDURE IS NOT COVERED BY CMS WHEN BILLED IN A SKILLED NURSING FACILITY","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y714","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X714","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X715","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y715","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y716","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 9 TIMES PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X716","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 9 TIMES PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X717","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 9 TIMES PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y717","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 9 TIMES PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y718","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN TWICE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X718","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN TWICE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X719","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 31 UNITS PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y719","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 31 UNITS PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X72","CODE NOT RECOGNIZED BY MEDICARE FOR OUTPATIENT CLAIMS; ALTERNATE CODE FOR SAME SERVICE MAY BE AVAILABLE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X720","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 31 UNITS PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y720","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 31 UNITS PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y721","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 124 UNITS PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X721","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN 124 UNITS PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X722","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN FOUR TIMES PER CALENDAR YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y722","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN FOUR TIMES PER CALENDAR YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y723","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X723","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X724","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN FOUR TIMES PER CALENDAR YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y724","UROLOGICAL SUPPLIES IS NOT COVERED BY CMS WHEN BILLED MORE THAN FOUR TIMES PER CALENDAR YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y725","PROCEDURE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X725","PROCEDURE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE PER CALENDAR MONTH","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X726","PROSTATE CANCER SCREENING IS NOT COVERED BY CMS IF BILLED MORE THAN ONCE IN AN 11 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y726","PROSTATE CANCER SCREENING IS NOT COVERED BY CMS IF BILLED MORE THAN ONCE IN AN 11 MONTH PERIOD","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y727","NEW TRACHEOSTOMY CARE KIT IS NOT COVERED BY CMS WHEN ACCOMPANYING OPEN SURGICAL TRACHEOSTOMY WAS NOT BILLED WITHIN THREE WEEKS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X727","NEW TRACHEOSTOMY CARE KIT IS NOT COVERED BY CMS WHEN ACCOMPANYING OPEN SURGICAL TRACHEOSTOMY WAS NOT BILLED WITHIN THREE WEEKS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X728","SERVICES CONSIDERED PART OF THE PEDIATRIC CRITICAL CARE INTERFACILITY TRANSPORT WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y728","SERVICES CONSIDERED PART OF THE PEDIATRIC CRITICAL CARE INTERFACILITY TRANSPORT WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y729","PER NCD GUIDELINES, CMS ID , A DIAGNOSIS CODE, WHICH MEETS MEDICAL NECESSITY FOR PROCEDURE CODE, IS MISSING OR INVALID.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X729","PER NCD GUIDELINES, CMS ID , A DIAGNOSIS CODE, WHICH MEETS MEDICAL NECESSITY FOR PROCEDURE CODE, IS MISSING OR INVALID.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X73","PARTIAL HOSPITALIZATION SERVICE FOR NON-MENTAL HEALTH DIAGNOSIS","","","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y730","PROSTATE SPECIFIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN TWICE IN A PATIENT'S LIFETIME.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X730","PROSTATE SPECIFIC ANTIGEN IS NOT COVERED BY MEDICARE WHEN BILLED MORE THAN TWICE IN A PATIENT'S LIFETIME.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X731","DEBRIDEMENT IS NOT COVERED BY CMS WHEN BILLED WITH PRESSURE ULCER STAGE I DIAGNOSIS AND NO OTHER PRESSURE ULCER STAGE DIAGNOSIS IS PRESENT ON THE CLAIM.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y731","DEBRIDEMENT IS NOT COVERED BY CMS WHEN BILLED WITH PRESSURE ULCER STAGE I DIAGNOSIS AND NO OTHER PRESSURE ULCER STAGE DIAGNOSIS IS PRESENT ON THE CLAIM.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y732","PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY, SINGLE DOSE VIAL CANNOT BE BILLED IN COMBINATION WITH PROCEDURES 95115-95117.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X732","PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY, SINGLE DOSE VIAL CANNOT BE BILLED IN COMBINATION WITH PROCEDURES 95115-95117.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X733","IMMUNIZATION ADMINISTRATION MUST BE BILLED WITH A VALID VACCINE/TOXOID CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y733","IMMUNIZATION ADMINISTRATION MUST BE BILLED WITH A VALID VACCINE/TOXOID CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y734","GLOBAL OBSTETRICAL DELIVERY WILL BE DENIED WHEN BILLED WITH AN ASSISTANT SURGEON MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X734","GLOBAL OBSTETRICAL DELIVERY WILL BE DENIED WHEN BILLED WITH AN ASSISTANT SURGEON MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X735","REIMBURSEMENT FOR AN ASSISTANT SURGEON WHEN BILLED BY THE PRIMARY SURGEON WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y735","REIMBURSEMENT FOR AN ASSISTANT SURGEON WHEN BILLED BY THE PRIMARY SURGEON WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y736","ONCE PER LIFETIME PROCEDURES OR SERVICES BILLED MORE THAN ONCE FOR A PATIENT, THE REPEATED SERVICE WILL BE DENIED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X736","ONCE PER LIFETIME PROCEDURES OR SERVICES BILLED MORE THAN ONCE FOR A PATIENT, THE REPEATED SERVICE WILL BE DENIED.","N117","This service is paid only once in a patient's lifetime.","CO","Contractual Obligations","35","Lifetime benefit maximum has been reached."]
["X737","DIRECT CONTACT PROLONGED PHYSICIAN SERVICE IN THE INPATIENT OR OBSERVATION SETTING MUST BE BILLED WITH AN INPATIENT PLACE OF SERVICE.","N428","Not covered when performed in this place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y737","DIRECT CONTACT PROLONGED PHYSICIAN SERVICE IN THE INPATIENT OR OBSERVATION SETTING MUST BE BILLED WITH AN INPATIENT PLACE OF SERVICE.","N428","Not covered when performed in this place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y738","DENY OB ULTRASOUND CODES 76802, 76810, 76812 WHEN BILLED WITHOUT THE REQUISITE DIAGNOSIS","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X738","DENY OB ULTRASOUND CODES 76802, 76810, 76812 WHEN BILLED WITHOUT THE REQUISITE DIAGNOSIS","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X739","ONLY ONE REIMBURSEMENT IS PERMITTED FOR ONCE-IN-A-LIFETIME SERVICES","N117","This service is paid only once in a patient's lifetime.","CO","Contractual Obligations","149","Lifetime benefit maximum has been reached for this service/benefit category."]
["Y739","ONLY ONE REIMBURSEMENT IS PERMITTED FOR ONCE-IN-A-LIFETIME SERVICES","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X74","INSUFFICIENT SERVICES ON DAY OF PARTIAL HOSPITALIZATION","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X740","GYNECOLOGIC SCREENING SERVICE WILL BE DENIED WHEN BILLED WITH PREVENTIVE MEDICINE VISITS OR ANNUAL GYN EXAM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y740","GYNECOLOGIC SCREENING SERVICE WILL BE DENIED WHEN BILLED WITH PREVENTIVE MEDICINE VISITS OR ANNUAL GYN EXAM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y741","RHYTHM ECG, INTERPRETATION AND REPORT ONLY BILLED WITH AN EVALUATION AND MANAGEMENT SERVICE IN THE HOSPITAL SETTING WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X741","RHYTHM ECG, INTERPRETATION AND REPORT ONLY BILLED WITH AN EVALUATION AND MANAGEMENT SERVICE IN THE HOSPITAL SETTING WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X742","E/M SERVICE BILLED WITH IMMUNIZATION ADMINISTRATION WILL BE DENIED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y742","E/M SERVICE BILLED WITH IMMUNIZATION ADMINISTRATION WILL BE DENIED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y743","C-CODE IS NOT VALID WHEN BILLED AS A PROFESSIONAL CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X743","C-CODE IS NOT VALID WHEN BILLED AS A PROFESSIONAL CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X744","SURGICAL DRESSINGS BILLED WITH INVALID PLACE OF SERVICE WILL BE DENIED","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y744","SURGICAL DRESSINGS BILLED WITH INVALID PLACE OF SERVICE WILL BE DENIED","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y745","SERVICE WITH A NON-FACILITY NA INDICATOR OF \"N/A\" WILL BE DENIED WHEN BILLED IN PHYSICIAN'S OFFICE PLACE OF SERVICE.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X745","SERVICE WITH A NON-FACILITY NA INDICATOR OF \"N/A\" WILL BE DENIED WHEN BILLED IN PHYSICIAN'S OFFICE PLACE OF SERVICE.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X746","STEREOTACTIC RADIOSURGERY BILLED MORE THAN ONCE WITHIN 90 DAYS WILL BE DENIED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y746","STEREOTACTIC RADIOSURGERY BILLED MORE THAN ONCE WITHIN 90 DAYS WILL BE DENIED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y747","TOPICAL APPLICATION OF OXYGEN/TOPICAL HYPERBARIC OXYGEN WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X747","TOPICAL APPLICATION OF OXYGEN/TOPICAL HYPERBARIC OXYGEN WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X748","AIR FLUIDIZED BED IS NOT COVERED WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y748","AIR FLUIDIZED BED IS NOT COVERED WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y749","HOME BLOOD GLUCOSE MONITOR IS NOT COVERED WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X749","HOME BLOOD GLUCOSE MONITOR IS NOT COVERED WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X75","PARTIAL HOSPITALIZATION ON SAME DAY AS ECT OR TYPE T PROCEDURE","","","CO","Contractual Obligations","233","Services/charges related to the treatment of a hospital-acquired condition or preventable medical error."]
["Y750","THERAPY FOR THE TREATMENT OF WOUNDS IS NOT COVERED WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X750","THERAPY FOR THE TREATMENT OF WOUNDS IS NOT COVERED WITHOUT AN APPROPRIATE DIAGNOSIS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X751","WOUND WARMING DEVICE IS NOT COVERED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y751","WOUND WARMING DEVICE IS NOT COVERED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y752","BONE DENSITY SERVICE REQUIRES AN APPROPRIATE DIAGNOSIS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X752","BONE DENSITY SERVICE REQUIRES AN APPROPRIATE DIAGNOSIS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X753","VITRECTOMIES BILLED WITHOUT A REQUIRED DIAGNOSIS CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y753","VITRECTOMIES BILLED WITHOUT A REQUIRED DIAGNOSIS CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y754","REFRACTIVE KERATOPLASTY WILL BE DENIED WHEN THE ONLY DIAGNOSIS CODE IS HYPEROPIA, MYOPIA OR ASTIGMATISM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X754","REFRACTIVE KERATOPLASTY WILL BE DENIED WHEN THE ONLY DIAGNOSIS CODE IS HYPEROPIA, MYOPIA OR ASTIGMATISM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X755","OFFICE CONSULTATION CODES BILLED WITH ROUTINE EXAMINATION DIAGNOSIS CODES WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y755","OFFICE CONSULTATION CODES BILLED WITH ROUTINE EXAMINATION DIAGNOSIS CODES WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y756","AUDITORY SCREENING BILLED WITH WITH PREVENTIVE MEDICINE VISITS WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X756","AUDITORY SCREENING BILLED WITH WITH PREVENTIVE MEDICINE VISITS WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X757","SPECIAL FUNCTION INTRAOCULAR LENS BILLED WITHOUT THE APPROPRIATE CATARACT REMOVAL SURGICAL CODES WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y757","SPECIAL FUNCTION INTRAOCULAR LENS BILLED WITHOUT THE APPROPRIATE CATARACT REMOVAL SURGICAL CODES WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y758","ALL USES OF SNCT TO DIAGNOSE SENSORY NEUROPATHIES OR RADICULOPATHIES ARE NONCOVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X758","ALL USES OF SNCT TO DIAGNOSE SENSORY NEUROPATHIES OR RADICULOPATHIES ARE NONCOVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X759","VAGUS NERVE STIMULATION BILLED WITH A DIAGNOSIS OF DEPRESSION WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y759","VAGUS NERVE STIMULATION BILLED WITH A DIAGNOSIS OF DEPRESSION WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X76","PARTIAL HOSPITALIZATION CLAIM SPANS 3 OR LESS DAYS WITH INSUFFICIENT SERVICES ON AT LEAST ONE OF THE DAYS","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X760","VISUAL ACUITY SCREENING WILL BE DENIED WHEN BILLED WITH E/M SERVICES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y760","VISUAL ACUITY SCREENING WILL BE DENIED WHEN BILLED WITH E/M SERVICES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y761","DIAGNOSTIC IMAGING PROCEDURE REQUIRES A VALID PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X761","DIAGNOSTIC IMAGING PROCEDURE REQUIRES A VALID PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X762","DIRECT LARYNGOSCOPY PERFORMED ON PATIENTS UNDER AGE 2 REQUIRES A VALID PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y762","DIRECT LARYNGOSCOPY PERFORMED ON PATIENTS UNDER AGE 2 REQUIRES A VALID PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y763","VIDEOFLUOROSCOPY/ENDOSCOPIC SWALLOWING STUDIES REQUIRES A VALID PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X763","VIDEOFLUOROSCOPY/ENDOSCOPIC SWALLOWING STUDIES REQUIRES A VALID PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X764","HYPERBARIC OXYGEN REQUIRES A VALID DIAGNOSIS AND PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y764","HYPERBARIC OXYGEN REQUIRES A VALID DIAGNOSIS AND PLACE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y765","GASTRIC FREEZING IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X765","GASTRIC FREEZING IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X766","VENIPUNCTURE BILLED WITHOUT A COVERED DIAGNOSIS CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y766","VENIPUNCTURE BILLED WITHOUT A COVERED DIAGNOSIS CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y767","CLINICAL TRIALS BILLED WITHOUT REQUIRED MODIFIER AND DIAGNOSIS CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X767","CLINICAL TRIALS BILLED WITHOUT REQUIRED MODIFIER AND DIAGNOSIS CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X768","SERVICES THAT ARE ELECTIVE IN NATURE AND DO NOT REMEDY A HEALTH STATE ARE CONSIDERED NONCOVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y768","SERVICES THAT ARE ELECTIVE IN NATURE AND DO NOT REMEDY A HEALTH STATE ARE CONSIDERED NONCOVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y769","DIGITAL RECTAL EXAMINATION BILLED WITH PREVENTIVE MEDICINE E/M CODES OR WELLNESS VISITS WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X769","DIGITAL RECTAL EXAMINATION BILLED WITH PREVENTIVE MEDICINE E/M CODES OR WELLNESS VISITS WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X77","PARTIAL HOSPITALIZATION CLAIM SPANS MORE THAN 3 DAYS WITH INSUFFICIENT NUMBER OF DAYS HAVING MENTAL HEALTH SERVICES","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y770","EXCISION/DESTRUCTION/CRYOTHERAPY OF BENIGN OR PREMALIGNANT SKIN LESIONS BILLED WITH INAPPROPRIATE PLACE OF SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X770","EXCISION/DESTRUCTION/CRYOTHERAPY OF BENIGN OR PREMALIGNANT SKIN LESIONS BILLED WITH INAPPROPRIATE PLACE OF SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X771","THERAPEUTIC, PROPHYLACTIC, AND DIAGNOSTIC INJECTIONS AND INFUSIONS BILLED WITH INAPPROPRIATE PLACE OF SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y771","THERAPEUTIC, PROPHYLACTIC, AND DIAGNOSTIC INJECTIONS AND INFUSIONS BILLED WITH INAPPROPRIATE PLACE OF SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y772","FABRIC WRAPPING OF ABDOMINAL ANEURYSMS IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X772","FABRIC WRAPPING OF ABDOMINAL ANEURYSMS IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X773","CELLULAR THERAPY IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y773","CELLULAR THERAPY IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y774","PROLOTHERAPY IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X774","PROLOTHERAPY IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X775","EDETATE DISODIUM, AND ITS RELATED ADMINISTRATIOM IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y775","EDETATE DISODIUM, AND ITS RELATED ADMINISTRATIOM IS A NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y776","LUMBAR ARTIFICIAL DISC REPLACEMENT IS NOT COVERED WHEN PATIENT'S IS GREATER THAN 60 YEARS.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X776","LUMBAR ARTIFICIAL DISC REPLACEMENT IS NOT COVERED WHEN PATIENT'S IS GREATER THAN 60 YEARS.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X777","WHEELCHAIR SEATING CODE BILLED IS NON-COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y777","WHEELCHAIR SEATING CODE BILLED IS NON-COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y778","E/M SERVICES BILLED WITH CRITICAL CARE SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X778","E/M SERVICES BILLED WITH CRITICAL CARE SERVICE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X779","DIAGNOSTIC ENDOCARDIAL ELECTRICAL STIMULATION IS NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE DIAGNOSIS","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y779","DIAGNOSTIC ENDOCARDIAL ELECTRICAL STIMULATION IS NOT COVERED BY CMS WHEN BILLED WITHOUT AN APPROPRIATE DIAGNOSIS","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X78","PARTIAL HOSPITALIZATION CLAIM SPANS MORE THAN 3 DAYS WITH INSUFFICIENT NUMBER OF DAYS MEETING PARTIAL HOSPITALIZATION CRITERIA","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X780","APPLICATION OF MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION ; EACH 15 MINUTES IS NOT COVERED WHEN BILLED FOR THE PURPOSE OF WOUND CARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y780","APPLICATION OF MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION ; EACH 15 MINUTES IS NOT COVERED WHEN BILLED FOR THE PURPOSE OF WOUND CARE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y781","ELECTRICAL STIMULATION/THERAPY IS NOT COVERED BY CMS IF BILLED IN NON-COVERED PLACE OF SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X781","ELECTRICAL STIMULATION/THERAPY IS NOT COVERED BY CMS IF BILLED IN NON-COVERED PLACE OF SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X782","HYPERBARIC OXYGEN REQUIRES A VALID DIAGNOSIS","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y782","HYPERBARIC OXYGEN REQUIRES A VALID DIAGNOSIS","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y783","NON-PHYSICIANS BILLING WITH MODIFIERS 80, 81 OR 82 WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X783","NON-PHYSICIANS BILLING WITH MODIFIERS 80, 81 OR 82 WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X784","PER MEDICARE'S ANATOMICAL MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS BILLED FOR PROCEDURE WITH ANATOMICAL MODIFIER EXCEED THE ALLOWED UNITS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y784","PER MEDICARE'S ANATOMICAL MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS BILLED FOR PROCEDURE WITH ANATOMICAL MODIFIER EXCEED THE ALLOWED UNITS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y785","LABOR & DELIVERY SERVICE IS NOT COVERED BY CMS WHEN BILLED IN CONJUNCTION WITH GLOBAL PACKAGE VIA CESAREAN DELIVERY. REVIEW HISTORICAL CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X785","LABOR & DELIVERY SERVICE IS NOT COVERED BY CMS WHEN BILLED IN CONJUNCTION WITH GLOBAL PACKAGE VIA CESAREAN DELIVERY. REVIEW HISTORICAL CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X786","C-SECTION DELIVERY SERVICE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE ON THE SAME DATE OF SERVICE.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y786","C-SECTION DELIVERY SERVICE IS NOT COVERED BY CMS WHEN BILLED MORE THAN ONCE ON THE SAME DATE OF SERVICE.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y787","PER CMS GUIDELINES, CO-SURGEON CLAIMS REQUIRE A VALID MODIFIER 62. REVIEW HISTORICAL CLAIM BILLED .","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X787","PER CMS GUIDELINES, CO-SURGEON CLAIMS REQUIRE A VALID MODIFIER 62. REVIEW HISTORICAL CLAIM BILLED .","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X788","PER CMS GUIDELINES, TEAM-SURGEON CLAIMS REQUIRE A VALID MODIFIER 66. REVIEW HISTORICAL CLAIM BILLED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y788","PER CMS GUIDELINES, TEAM-SURGEON CLAIMS REQUIRE A VALID MODIFIER 66. REVIEW HISTORICAL CLAIM BILLED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X789","PER AMA GUIDELINES, INITIAL NEONATAL AND PEDIATRIC CRITICAL CARE WILL BE DENIED WHEN THE PATIENT HAS HAD INPATIENT CRITICAL CARE SERVICES THE PREVIOUS DAY. REVIEW HISTORICAL CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y789","PER AMA GUIDELINES, INITIAL NEONATAL AND PEDIATRIC CRITICAL CARE WILL BE DENIED WHEN THE PATIENT HAS HAD INPATIENT CRITICAL CARE SERVICES THE PREVIOUS DAY. REVIEW HISTORICAL CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X79","ONLY MENTAL HEALTH EDUCATION AND TRAINING SERVICES PROVIDED","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X790","PROFESSIONAL RADIOLOGY SERVICES BILLED BY A PROVIDER OTHER THAN AN ANESTHESIOLOGIST, CARDIOLOGIST, MULTISPECIALIST, NEUROLOGIST, PHYSICAL MEDICINE SPECIALIST, RADIOLOGIST, OR RADIATION ONCOLOGIST IN THE IP OR OP HOSPITAL SETTING WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y790","PROFESSIONAL RADIOLOGY SERVICES BILLED BY A PROVIDER OTHER THAN AN ANESTHESIOLOGIST, CARDIOLOGIST, MULTISPECIALIST, NEUROLOGIST, PHYSICAL MEDICINE SPECIALIST, RADIOLOGIST, OR RADIATION ONCOLOGIST IN THE IP OR OP HOSPITAL SETTING WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y791","DURABLE MEDICAL EQUIPMENT OVER $300 REQUIRES PRE AUTH.","N758","Adjusted based on the prior authorization decision.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["X791","DURABLE MEDICAL EQUIPMENT OVER $300 REQUIRES PRE AUTH.","N758","Adjusted based on the prior authorization decision.","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["X792","DROP MEDICALLY UNLIKELY EDIT FOR EXCLUDED MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y792","DROP MEDICALLY UNLIKELY EDIT FOR EXCLUDED MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y793","DROP MODIFIER 26 REQUIREMENT WHEN POS IS 24.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X793","DROP MODIFIER 26 REQUIREMENT WHEN POS IS 24.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X794","DROP BUNDLED SERVICE EDIT FOR PROCEDURE CODE 99050.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y794","DROP BUNDLED SERVICE EDIT FOR PROCEDURE CODE 99050.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y795","A MULTIPLE PROCEDURE REDUCTION OF APPLIES TO PROCEDURE CODE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X795","A MULTIPLE PROCEDURE REDUCTION OF APPLIES TO PROCEDURE CODE.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X796","ANESTHESIA CODE REQUIRES AN APPROPRIATE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y796","ANESTHESIA CODE REQUIRES AN APPROPRIATE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y797","REVENUE CODE REQUIRES PROCEDURE CODE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X797","REVENUE CODE REQUIRES PROCEDURE CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X798","CLINIC VISIT SHOULD BE BILLED ON PROFESSIONAL CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y798","CLINIC VISIT SHOULD BE BILLED ON PROFESSIONAL CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y799","PROCEDURE CODES WITH SURGERY INDICATOR I CAN NOT BE BILLED WITH SURGERY INDICATOR M OR E&M PROCEDURE CODE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X8","THE PRINCIPAL DIAGNOSIS IS A DUPLICATE OF THE SECONDARY DIAGNOSIS","N702","Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y8","THE PRINCIPAL DIAGNOSIS IS A DUPLICATE OF THE SECONDARY DIAGNOSIS","N702","Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X80","EXTENSIVE MENTAL HEALTH SERVICES PROVIDED ON DAY OF TYPE T PROCEDURE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["X800","REVENUE CODE INVALID FOR ILLINOIS MEDICAID HOSPITAL PROVIDERS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y800","REVENUE CODE INVALID FOR ILLINOIS MEDICAID HOSPITAL PROVIDERS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y801","TAXONOMY REIMBURSES AT PERCENTAGE OF PHYSICIAN FEE SCHEDULE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X801","TAXONOMY REIMBURSES AT PERCENTAGE OF PHYSICIAN FEE SCHEDULE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X802","A MULTIPLE PROCEDURE REDUCTION APPLIES TO PROCEDURE CODE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y802","A MULTIPLE PROCEDURE REDUCTION APPLIES TO PROCEDURE CODE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y803","ASSISTANT SURGEON MODIFIER INDICATES A 20% REDUCTION OF THE STATE MAXIMUM SHOUD BE APPLIED.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X803","ASSISTANT SURGEON MODIFIER INDICATES A 20% REDUCTION OF THE STATE MAXIMUM SHOUD BE APPLIED.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X804","ASSISTANT SURGEON MODIFIER NOT APPLICABLE FOR PROCEDURE CODE. LINE ITEM NOT REIMBURSED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y804","ASSISTANT SURGEON MODIFIER NOT APPLICABLE FOR PROCEDURE CODE. LINE ITEM NOT REIMBURSED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y805","ALLOWANCES FOR SURGERY PERFORMED UNDER THE SURGICAL TEAM CONCEPT WILL BE DETERMINED ON A BY REPORT BASIS. LINE NOT REIMBURSED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X805","ALLOWANCES FOR SURGERY PERFORMED UNDER THE SURGICAL TEAM CONCEPT WILL BE DETERMINED ON A BY REPORT BASIS. LINE NOT REIMBURSED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X806","TEAM SURGERY MODIFIER NOT APPLICABLE FOR PROCEDURE CODE. LINE ITEM NOT REIMBURSED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y806","TEAM SURGERY MODIFIER NOT APPLICABLE FOR PROCEDURE CODE. LINE ITEM NOT REIMBURSED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y807","DME CODE REQUIRES A PURCHASE OR RENTAL MODIFIER","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X807","DME CODE REQUIRES A PURCHASE OR RENTAL MODIFIER","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X808","PROCEDURE CODE 01996 (DAILY MANAGEMENT OF EPIDURAL OR SUBARACHNOID DRUG ADMINISTRATION) CANNOT BE BILLED WITH A SURGICAL PROCEDURE FOR THE SAME DATE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y808","PROCEDURE CODE 01996 (DAILY MANAGEMENT OF EPIDURAL OR SUBARACHNOID DRUG ADMINISTRATION) CANNOT BE BILLED WITH A SURGICAL PROCEDURE FOR THE SAME DATE OF SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y809","SACRAL NERVE NEUROTRANSMITTER IMPLANT BILLED WITH A VOIDING DYSFUNCTION DIAGNOSIS IS DENIED WHEN A TEST PROCEDURE HAS NOT BEEN BILLED IN THE PREVIOUS 6 MONTHS FOR THE SAME DIAGNOSIS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X809","SACRAL NERVE NEUROTRANSMITTER IMPLANT BILLED WITH A VOIDING DYSFUNCTION DIAGNOSIS IS DENIED WHEN A TEST PROCEDURE HAS NOT BEEN BILLED IN THE PREVIOUS 6 MONTHS FOR THE SAME DIAGNOSIS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X81","TERMINATED BILATERAL PROCEDURE OR TERMINATED PROCEDURE WITH UNITS GREATER THAN ONE","N430","Procedure code is inconsistent with the units billed.","CO","Contractual Obligations","115","Procedure postponed, canceled, or delayed."]
["Y810","E/M SERVICE IS NOT PERMITTED IN THIS POS .","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X810","E/M SERVICE IS NOT PERMITTED IN THIS POS .","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X811","ONLY ONE E&M CODE IS ALLOWED PER DOS PER FACILITY FOR THE SAME REVENUE CODE. A HIGHER-DOLLAR-APC E&M PROC WAS FOUND ON  CLAIM IN HISTORY, SO THIS LINE IS DENIED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y811","ONLY ONE E&M CODE IS ALLOWED PER DOS PER FACILITY FOR THE SAME REVENUE CODE. A HIGHER-DOLLAR-APC E&M PROC WAS FOUND ON  CLAIM IN HISTORY, SO THIS LINE IS DENIED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y812","SURGICAL DRESSING MUST BE BILLED WITH A1-A9 MODIFIER","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X812","SURGICAL DRESSING MUST BE BILLED WITH A1-A9 MODIFIER","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X813","COLON CANCER SCREENING IS NOT COVERED FOR PATIENTS UNDER THE AGE OF 50.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y813","COLON CANCER SCREENING IS NOT COVERED FOR PATIENTS UNDER THE AGE OF 50.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y814","E&M SERVICE BILLED ON THE SAME DATE AS ELECTROMYOGRAPHY, NERVE CONDUCTION TESTS OR REFLEX TESTS WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X814","E&M SERVICE BILLED ON THE SAME DATE AS ELECTROMYOGRAPHY, NERVE CONDUCTION TESTS OR REFLEX TESTS WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X815","EVALUATION AND MANAGEMENT SERVICES BILLED THE SAME DATE AS ACUPUNCTURE SERVICES WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y815","EVALUATION AND MANAGEMENT SERVICES BILLED THE SAME DATE AS ACUPUNCTURE SERVICES WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y816","INITIAL MEDICATION THERAPY MANAGEMENT SERVICE FOR A NEW PATIENT BILLED WITHIN A YEAR OF A PREVIOUS 99605 OR 99606 WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X816","INITIAL MEDICATION THERAPY MANAGEMENT SERVICE FOR A NEW PATIENT BILLED WITHIN A YEAR OF A PREVIOUS 99605 OR 99606 WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X817","INPATIENT ONLY, NON-SEPARATE PROCEDURE CPT BILLED BY PROFESSIONAL PROVIDERS WITH ANY PLACE OF SERVICE OTHER THAN 21 WILL BE DENIED.","M2","Not paid separately when the patient is an inpatient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y817","INPATIENT ONLY, NON-SEPARATE PROCEDURE CPT BILLED BY PROFESSIONAL PROVIDERS WITH ANY PLACE OF SERVICE OTHER THAN 21 WILL BE DENIED.","M2","Not paid separately when the patient is an inpatient.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y818","G0446 (ANNUAL, FACE-TO-FACE IBT FOR CVD) IS LIMITED TO ONE (1) UNIQUE VISIT PER YEAR.","M90","Not covered more than once in a 12 month period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X818","G0446 (ANNUAL, FACE-TO-FACE IBT FOR CVD) IS LIMITED TO ONE (1) UNIQUE VISIT PER YEAR.","M90","Not covered more than once in a 12 month period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X819","PHOTOPHERESIS, EXTRACORPOREAL BILLED WITHOUT A DIAGNOSIS FOR THE UNDERLYING CAUSE WILL BE DENIED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y819","PHOTOPHERESIS, EXTRACORPOREAL BILLED WITHOUT A DIAGNOSIS FOR THE UNDERLYING CAUSE WILL BE DENIED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X82","INCONSISTENCY BETWEEN IMPLANTED DEVICE OR ADMINISTERED SUBSTANCE AND IMPLANTATION OR ASSOCIATED PROCEDURE","","","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["X820","PHOTOPHERESIS, EXTRACORPOREAL BILLED WITH GRAFT-VERSUS-HOST-DISEASE WITHOUT A DIAGNOSIS OF COMPLICATIONS OF HEART TRANSPLANT, BONE MARROW TRANSPLANT OR STEM CELL TRANSPLANT WILL BE DENIED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y820","PHOTOPHERESIS, EXTRACORPOREAL BILLED WITH GRAFT-VERSUS-HOST-DISEASE WITHOUT A DIAGNOSIS OF COMPLICATIONS OF HEART TRANSPLANT, BONE MARROW TRANSPLANT OR STEM CELL TRANSPLANT WILL BE DENIED.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y821","TAPE (A4450, A4452) IS DENIED WHEN BILLED WITHOUT MODIFIERS AU, AV, AW, AX.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X821","TAPE (A4450, A4452) IS DENIED WHEN BILLED WITHOUT MODIFIERS AU, AV, AW, AX.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X822","OSTEOGENESIS STIMULATORS DESCRIBED BY HCPCS CODES E0747, E0748, AND E0760 ARE CLASSIFIED AS CLASS III DEVICES WHICH MUST BE SUBMITTED WITH MODIFIER KF.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y822","OSTEOGENESIS STIMULATORS DESCRIBED BY HCPCS CODES E0747, E0748, AND E0760 ARE CLASSIFIED AS CLASS III DEVICES WHICH MUST BE SUBMITTED WITH MODIFIER KF.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y823","DIAGNOSTIC SERVICES OR OP NON-REHABILITATION SERVICES BILLED WITH THERAPY SERVICES MODIFIERS WILL BE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X823","DIAGNOSTIC SERVICES OR OP NON-REHABILITATION SERVICES BILLED WITH THERAPY SERVICES MODIFIERS WILL BE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X824","SERVICE INAPPROPRIATELY BILLED WITH TELEHEALTH SERVICE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y824","SERVICE INAPPROPRIATELY BILLED WITH TELEHEALTH SERVICE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y825","CPT CARE PLAN OVERSIGHT SERVICES WHEN BILLED WITHIN THE SAME CALENDAR MONTH OF A MONTHLY ESRD SERVICES CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X825","CPT CARE PLAN OVERSIGHT SERVICES WHEN BILLED WITHIN THE SAME CALENDAR MONTH OF A MONTHLY ESRD SERVICES CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X826","CPT (INJECTION, LEVOCARNITINE) MUST BE BILLED WITH APPROPRIATE DIAGNOSIS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y826","CPT (INJECTION, LEVOCARNITINE) MUST BE BILLED WITH APPROPRIATE DIAGNOSIS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y827","PHYSICIAN RECERTIFICATION FOR HOME HEALTH SERVICES (G0179) IS DENIED IF BILLED MORE THAN ONCE EVERY TWO MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X827","PHYSICIAN RECERTIFICATION FOR HOME HEALTH SERVICES (G0179) IS DENIED IF BILLED MORE THAN ONCE EVERY TWO MONTHS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X828","T1001 (NURSING ASSESSMENT EVALUATION) CANNOT BE BILLED MORE THAN ONCE A MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y828","T1001 (NURSING ASSESSMENT EVALUATION) CANNOT BE BILLED MORE THAN ONCE A MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y829","EXCISION/DESTRUCTION/CRYOTHERAPY OF BENIGN OR PREMALIGNANT SKIN LESIONS BILLED WITH INAPPROPRIATE POS WILL BE DENIED.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X829","EXCISION/DESTRUCTION/CRYOTHERAPY OF BENIGN OR PREMALIGNANT SKIN LESIONS BILLED WITH INAPPROPRIATE POS WILL BE DENIED.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X83","MUTUALLY EXCLUSIVE PROCEDURE THAT WOULD BE ALLOWED BY NCCI IF APPROPRIATE MODIFIER WERE PRESENT","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y830","EXCISION/DESTRUCTION/CRYOTHERAPY OF BENIGN OR PREMALIGNANT SKIN LESIONS BILLED WITH INAPPROPRIATE POS WILL BE DENIED.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X830","EXCISION/DESTRUCTION/CRYOTHERAPY OF BENIGN OR PREMALIGNANT SKIN LESIONS BILLED WITH INAPPROPRIATE POS WILL BE DENIED.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X831","MAX OF ONE FECAL OCCULT BLOOD TEST CPT IS ALLOWED PER YEAR.","M90","Not covered more than once in a 12 month period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y831","MAX OF ONE FECAL OCCULT BLOOD TEST CPT IS ALLOWED PER YEAR.","M90","Not covered more than once in a 12 month period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y832","MAX OF ONE SIGMOIDOSCOPY OR BARIUM ENEMA CPT IS ALLOWED EVERY FOUR YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X832","MAX OF ONE SIGMOIDOSCOPY OR BARIUM ENEMA CPT IS ALLOWED EVERY FOUR YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X833","BARIUM ENEMA HIGH RISK ALTERNATIVE TO SCREENING COLONOSCOPY CPT IS NOT COVERED WHEN BILLED WITHOUT A HIGH RISK DIAGNOSIS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y833","BARIUM ENEMA HIGH RISK ALTERNATIVE TO SCREENING COLONOSCOPY CPT IS NOT COVERED WHEN BILLED WITHOUT A HIGH RISK DIAGNOSIS.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y834","WHEN THE DIAGNOSIS IS NOT MULTIPLE GESTATION, THE MAXIMUM UNIT ALLOWED FOR PROCEDURE IS 1 PER DAY.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X834","WHEN THE DIAGNOSIS IS NOT MULTIPLE GESTATION, THE MAXIMUM UNIT ALLOWED FOR PROCEDURE IS 1 PER DAY.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X835","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, ULTRASOUNDS HAVE MAXIMUM UNITS PER DAY RESTRICTIONS.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y835","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, ULTRASOUNDS HAVE MAXIMUM UNITS PER DAY RESTRICTIONS.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y836","CPT ADVANCED KNEES, ANKLES AND FEET WITHOUT AN APPROPRIATE K3 OR K4 FUNCTIONAL MODIFIER WILL BE DENIED","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X836","CPT ADVANCED KNEES, ANKLES AND FEET WITHOUT AN APPROPRIATE K3 OR K4 FUNCTIONAL MODIFIER WILL BE DENIED","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X837","MORE SPECIFIC CODING AVAILABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y837","MORE SPECIFIC CODING AVAILABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y838","PRIVATE DUTY NURSING WILL NOT EXCEED 96 UNITS PER 24 HOUR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X838","PRIVATE DUTY NURSING WILL NOT EXCEED 96 UNITS PER 24 HOUR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X839","PRIVATE DUTY NURSING WILL NOT EXCEED 8000 UNITS PER CALENDAR YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y839","PRIVATE DUTY NURSING WILL NOT EXCEED 8000 UNITS PER CALENDAR YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X84","CODE2 OF A CODE PAIR THAT WOULD BE ALLOWED BY NCCI IF APPROPRIATE MODIFIER WERE PRESENT","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X840","DENTAL CODES HAVE A COVERAGE LIMIT OF ONCE PER YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y840","DENTAL CODES HAVE A COVERAGE LIMIT OF ONCE PER YEAR","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y841","DENTAL SEALANT PER TOOTH - MAXIMUM UNITS PAYABLE = 8","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X841","DENTAL SEALANT PER TOOTH - MAXIMUM UNITS PAYABLE = 8","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y842","CHIROPRACTIC MANIPULATIVE TREATMENT BILLED MORE THAN ONCE PER DAY, WHEN BILLED BY ANY PROVIDER WILL BE DENIED.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y843","MOD 79 INDICATES A 2ND PROCEDURE BY SAME PHYS IS UNRELATED TO A PRIOR PROCEDURE, BUT NO PRIOR PROCEDURES (WITHIN 90 DAYS) WERE FOUND WITH GLOBAL POST-OP PERIODS CONTAINING THIS DOS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X843","MOD 79 INDICATES A 2ND PROCEDURE BY SAME PHYS IS UNRELATED TO A PRIOR PROCEDURE, BUT NO PRIOR PROCEDURES (WITHIN 90 DAYS) WERE FOUND WITH GLOBAL POST-OP PERIODS CONTAINING THIS DOS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X844","PROC BILLED WITH MOD 54, 55 OR 56 IS DENIED BECAUSE IT WAS BILLED PREVIOUSLY, WITHOUT A MODIFIER, ON CLAIM IN HISTORY.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y844","PROC BILLED WITH MOD 54, 55 OR 56 IS DENIED BECAUSE IT WAS BILLED PREVIOUSLY, WITHOUT A MODIFIER, ON CLAIM IN HISTORY.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y845","MOD 76 INDICATES REPEAT PROCEDURE BY SAME PHYS, BUT NO PRIOR INSTANCE OF THIS PROCEDURE WAS FOUND (WITHIN 90 DAYS).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X845","MOD 76 INDICATES REPEAT PROCEDURE BY SAME PHYS, BUT NO PRIOR INSTANCE OF THIS PROCEDURE WAS FOUND (WITHIN 90 DAYS).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X846","MOD 77 INDICATES A REPEAT PROCEDURE BY A DIFFERENT PHYS, BUT NO PRIOR INSTANCE OF THIS PROCEDURE WAS FOUND (WITHIN 90 DAYS).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y846","MOD 77 INDICATES A REPEAT PROCEDURE BY A DIFFERENT PHYS, BUT NO PRIOR INSTANCE OF THIS PROCEDURE WAS FOUND (WITHIN 90 DAYS).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y847","MOD 77 INDICATES A REPEAT PROCEDURE BY A DIFFERENT PHYS. PROCEDURE {0} IS DENIED BECAUSE IT WAS BILLED BY THE SAME PHYS WITHIN THE {1}-DAY GLOBAL POST OPERATIVE PERIOD FOR {2} ON CLAIM {3}.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X847","MOD 77 INDICATES A REPEAT PROCEDURE BY A DIFFERENT PHYS. PROCEDURE {0} IS DENIED BECAUSE IT WAS BILLED BY THE SAME PHYS WITHIN THE {1}-DAY GLOBAL POST OPERATIVE PERIOD FOR {2} ON CLAIM {3}.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X848","PROCS WITHOUT MOD 54, 55 OR 56 ARE DENIED WHEN SAME PROC WAS PREVIOUSLY BILLED BY ANOTHER PHYS WITH 54, 55 OR 56 (CLAIM NUMBER {0}).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y848","PROCS WITHOUT MOD 54, 55 OR 56 ARE DENIED WHEN SAME PROC WAS PREVIOUSLY BILLED BY ANOTHER PHYS WITH 54, 55 OR 56 (CLAIM NUMBER {0}).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y849","MODIFIER 51 SUBMITTED WITH AN ADD-ON PROCEDURE CODE WILL BE DENIED.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X849","MODIFIER 51 SUBMITTED WITH AN ADD-ON PROCEDURE CODE WILL BE DENIED.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X85","INVALID REVENUE CODE","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y850","CPT ADVANCED KNEES, ANKLES AND FEET WITHOUT AN APPROPRIATE K2, K3 OR K4 FUNCTIONAL MODIFIER WILL BE DENIED","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X850","CPT ADVANCED KNEES, ANKLES AND FEET WITHOUT AN APPROPRIATE K2, K3 OR K4 FUNCTIONAL MODIFIER WILL BE DENIED","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X851","CPT SPINAL ORTHOSIS PROCEDURES MUST BE BILLED WITH CG MODIFIER","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y851","CPT SPINAL ORTHOSIS PROCEDURES MUST BE BILLED WITH CG MODIFIER","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y852","PROCEDURES WITH MODIFIER 55 OR 56, IN ADDITION TO MODIFIER 78, ARE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X852","PROCEDURES WITH MODIFIER 55 OR 56, IN ADDITION TO MODIFIER 78, ARE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X853","DEVICE IS INTEGRAL TO A COVERED ASC SURGICAL PROCEDURE, BUT NO CORRESPONDING ASC SURGICAL PROCEDURE WAS FOUND FOR SAME DOS.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y853","DEVICE IS INTEGRAL TO A COVERED ASC SURGICAL PROCEDURE, BUT NO CORRESPONDING ASC SURGICAL PROCEDURE WAS FOUND FOR SAME DOS.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y854","EVALUATION AND MANAGEMENT SERVICES ARE NOT SEPARATELY PAYABLE WHEN BILLED WITH 93701 (BIOIMPEDANCE, THORACIC, ELECTRICAL) AND THE PLACE OF SERVICE IS NOT 21 (INPATIENT HOSPITAL), 22 (OUTPATIENT HOSPITAL), 23 (EMERGENCY DEPARTMENT).","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X854","EVALUATION AND MANAGEMENT SERVICES ARE NOT SEPARATELY PAYABLE WHEN BILLED WITH 93701 (BIOIMPEDANCE, THORACIC, ELECTRICAL) AND THE PLACE OF SERVICE IS NOT 21 (INPATIENT HOSPITAL), 22 (OUTPATIENT HOSPITAL), 23 (EMERGENCY DEPARTMENT).","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X855","E&M CODE IS NOT COVERED BY CMS WHEN BILLED IN A PLACE OF SERVICE ON CLAIM.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y855","E&M CODE IS NOT COVERED BY CMS WHEN BILLED IN A PLACE OF SERVICE ON CLAIM.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y856","HOME HEALTH/HOME INFUSION PROCEDURE REQUIRES A VALID MODIFIER SS AND A VALID PLACE OF SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X856","HOME HEALTH/HOME INFUSION PROCEDURE REQUIRES A VALID MODIFIER SS AND A VALID PLACE OF SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X857","G0446 (ANNUAL, FACE-TO-FACE IBT FOR CVD) IS DENIED WHEN POS IS NOT 11, 22, 49, 50, 71, 72","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y857","G0446 (ANNUAL, FACE-TO-FACE IBT FOR CVD) IS DENIED WHEN POS IS NOT 11, 22, 49, 50, 71, 72","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y858","SURGICAL AND MEDICAL SERVICE IS DENIED BECAUSE IT WAS BILLED WITHIN DAY GLOBAL POST OPERATIVE PERIOD FOR ON CLAIM.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X858","SURGICAL AND MEDICAL SERVICE IS DENIED BECAUSE IT WAS BILLED WITHIN DAY GLOBAL POST OPERATIVE PERIOD FOR ON CLAIM.","N525","These services are not covered when performed within the global period of another service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X859","ONLY ONE TECHNICAL COMPONENT FOR THE SAME SERVICE MAY BE BILLED. A SIMILAR SERVICE WAS BILLED ON CLAIM IN HISTORY.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y859","ONLY ONE TECHNICAL COMPONENT FOR THE SAME SERVICE MAY BE BILLED. A SIMILAR SERVICE WAS BILLED ON CLAIM IN HISTORY.","N522","Duplicate of a claim processed, or to be processed, as a crossover claim.","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X86","MULTIPLE MEDICAL VISITS ON SAME DAY WITH SAME REVENUE CODE WITHOUT CONDITION CODE G0","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","236","This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements."]
["X860","CPT 93701 (BIOIMPEDANCE, THORACIC, ELECTRICAL) IS DENIED WHEN BILLED ON THE SAME DATE OF SERVICE AS CARDIAC BYPASS SURGERY (33510-33536), WHICH APPEARS ON CLAIM #{0}.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y860","CPT 93701 (BIOIMPEDANCE, THORACIC, ELECTRICAL) IS DENIED WHEN BILLED ON THE SAME DATE OF SERVICE AS CARDIAC BYPASS SURGERY (33510-33536), WHICH APPEARS ON CLAIM #{0}.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y861","CPT 93701 (BIOIMPEDANCE, THORACIC, ELECTRICAL) IS DENIED WHEN THE ONLY DIAGNOSIS ON THE CLAIM IS AORTIC VALVE REGURGITATION OR HYPERTENSION.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X861","CPT 93701 (BIOIMPEDANCE, THORACIC, ELECTRICAL) IS DENIED WHEN THE ONLY DIAGNOSIS ON THE CLAIM IS AORTIC VALVE REGURGITATION OR HYPERTENSION.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X862","CORRECT NDC CODE REQUIRED.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y862","CORRECT NDC CODE REQUIRED.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y863","HCPCS CODE IS NOT ON THE ASP DRUG SCHEDULE AND NDC IS NOT ON NOC SO THE CHARGE IS NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X863","HCPCS CODE IS NOT ON THE ASP DRUG SCHEDULE AND NDC IS NOT ON NOC SO THE CHARGE IS NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X864","INAPPROPRIATE CODING FOR CONTRACT AGREEMENT: HCPCS CATEGORY II CODE IS REQUIRED","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y864","INAPPROPRIATE CODING FOR CONTRACT AGREEMENT: HCPCS CATEGORY II CODE IS REQUIRED","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y865","AN NDC CODE WITHOUT A CPT CODE IS NOT PERMITTED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X865","AN NDC CODE WITHOUT A CPT CODE IS NOT PERMITTED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X866","DROP NCCI (VCE.49950/VCE.49951) FOR PROCEDURE CODES 59425 OR 59426 WITH APPROPRIATE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y866","DROP NCCI (VCE.49950/VCE.49951) FOR PROCEDURE CODES 59425 OR 59426 WITH APPROPRIATE MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y867","PHYSICAL STATUS MODIFIER MUST BE THE FIRST MODIFIER ON THE CLAIM.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X867","PHYSICAL STATUS MODIFIER MUST BE THE FIRST MODIFIER ON THE CLAIM.","N439","Missing anesthesia physical status report/indicators.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X868","REVENUE CODE IS INVALID FOR LTC PROVIDER.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y868","REVENUE CODE IS INVALID FOR LTC PROVIDER.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y869","BEHAVIORAL HEALTH PROVIDER REQUIRES MODIFIER ON THE ENCOUNTER CODE .","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X869","BEHAVIORAL HEALTH PROVIDER REQUIRES APPROPRIATE MODIFIER ON THE ENCOUNTER CODE.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X87","TRANSFUSION OR BLOOD PRODUCT EXCHANGE WITHOUT SPECIFICATION OF BLOOD PRODUCT","M84","Medical code sets used must be the codes in effect at the time of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y870","ENCOUNTER RATE CLINICS REQUIRE A DETAIL CODE.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X870","ENCOUNTER RATE CLINICS REQUIRE A DETAIL CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X871","ENCOUNTER RATE CLINICS SHOULD BE BILLED AS A SINGLE DATE OF SERVICE.","N800","Only one service date is allowed per claim.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y871","ENCOUNTER RATE CLINICS SHOULD BE BILLED AS A SINGLE DATE OF SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y872","REIMBURSEMENT FOR THIS SERVICE IS INCLUDED IN THE FQHC VISIT (G CODE).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X872","REIMBURSEMENT FOR THIS SERVICE IS INCLUDED IN THE FQHC VISIT (G CODE).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X873","DASA MUST BE BILLED ON TYPE OF BILL 86X OR 89X","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y873","DASA MUST BE BILLED ON TYPE OF BILL 86X OR 89X","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y874","INFERTILITY DIAGNOSES ARE NON COVERED FOR ILLINOIS MEDICAID","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X874","INFERTILITY DIAGNOSES ARE NON COVERED FOR ILLINOIS MEDICAID","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X875","MATERNITY/ANTEPARTUM CODE IS CONSIDERED GLOBAL BY HFS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y875","MATERNITY/ANTEPARTUM CODE IS CONSIDERED GLOBAL BY HFS","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y876","OCCURRENCE CODE 51 IS NO LONGER VALID. OCCURRENCE CODE 42 IS NOW REQUIRED.","M45","Missing/incomplete/invalid occurrence code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X876","OCCURRENCE CODE 51 IS NO LONGER VALID. OCCURRENCE CODE 42 IS NOW REQUIRED.","M45","Missing/incomplete/invalid occurrence code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X877","NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y877","NON-COVERED SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y878","THERAPY MODIFIER REDUCES TO PERCENTAGE OF THE ALLOWED AMOUNT.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X878","THERAPY MODIFIER REDUCES TO PERCENTAGE OF THE ALLOWED AMOUNT.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X879","PROFESSIONAL CLAIM IS A POSSIBLE DUPLICATE OF CLAIM IN HISTORY.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y879","PROFESSIONAL CLAIM IS A POSSIBLE DUPLICATE OF CLAIM IN HISTORY.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X88","OBSERVATION REVENUE CODE ON LINE ITEM WITH NON-OBSERVATION HCPCS CODE","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X880","PROFESSIONAL CLAIM LINE IS A POSSIBLE DUPLICATE OF CLAIM LINE ID.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y880","PROFESSIONAL CLAIM LINE IS A POSSIBLE DUPLICATE OF CLAIM LINE ID.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y881","OUTPATIENT CLAIM IS A POSSIBLE DUPLICATE OF CLAIM IN HISTORY.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X881","OUTPATIENT CLAIM IS A POSSIBLE DUPLICATE OF CLAIM IN HISTORY.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X882","OUTPATIENT CLAIM LINE IS A POSSIBLE DUPLICATE OF CLAIM LINE IN HISTORY. (SAME CLAIM)","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y882","OUTPATIENT CLAIM LINE IS A POSSIBLE DUPLICATE OF CLAIM LINE IN HISTORY. (SAME CLAIM)","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y883","OUTPATIENT CLAIM LINE IS A POSSIBLE DUPLICATE OF CLAIM LINE. (HISTORICAL CLAIM)","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X883","OUTPATIENT CLAIM LINE IS A POSSIBLE DUPLICATE OF CLAIM LINE. (HISTORICAL CLAIM)","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["X884","INPATIENT CLAIM IS A POSSIBLE DUPLICATE OF CLAIM IN HISTORY.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y884","INPATIENT CLAIM IS A POSSIBLE DUPLICATE OF CLAIM IN HISTORY.","","","CO","Contractual Obligations","18","Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)"]
["Y885","THIS OP REVENUE CODE IS NOT ON THE LIST OF PAYABLE CODES SPECIFIED BY THE KENTUCKY MEDICAID BILLING MANUAL FOR OP HOSPITAL SERVICES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X885","THIS OP REVENUE CODE IS NOT ON THE LIST OF PAYABLE CODES SPECIFIED BY THE KENTUCKY MEDICAID BILLING MANUAL FOR OP HOSPITAL SERVICES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X886","DIAGNOSIS IS CONSIDERED AN ADDITIONAL CODE AND SHOULD NOT BE SUBMITTED AS PRIMARY.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y886","DIAGNOSIS IS CONSIDERED AN ADDITIONAL CODE AND SHOULD NOT BE SUBMITTED AS PRIMARY.","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y887","DISCREPANCY IN COVERED DAYS (VALUE CODE 80) AND UNITS BILLED ON ROOM AND BOARD REVENUE CODES (0100-0219) .","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X887","DISCREPANCY IN COVERED DAYS (VALUE CODE 80) AND UNITS BILLED ON ROOM AND BOARD REVENUE CODES (0100-0219) .","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X888","CHALLENGE INGESTION FOOD TESTING WILL BE DENIED IF BILLED WITH INAPPROPRIATE DIAGNOSIS CODE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y888","CHALLENGE INGESTION FOOD TESTING WILL BE DENIED IF BILLED WITH INAPPROPRIATE DIAGNOSIS CODE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y889","HYDROPHILIC CONTACT LENSES BILLED WITH ONLY NONDISEASED EYES WITH SPHERICAL AMETROPIA, REFRACTIVE ASTIGMATISM, AND/OR CORNEAL ASTIGMATISM DIAGNOSIS CODE ARE NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X889","HYDROPHILIC CONTACT LENSES BILLED WITH ONLY NONDISEASED EYES WITH SPHERICAL AMETROPIA, REFRACTIVE ASTIGMATISM, AND/OR CORNEAL ASTIGMATISM DIAGNOSIS CODE ARE NOT COVERED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X89","INPATIENT SEPARATE PROCEDURES NOT PAID","M2","Not paid separately when the patient is an inpatient.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y890","DENY 90935-90940 (HEMODIALYSIS) WHEN BILLED AND THE ONLY DIAGNOSIS ON THE CLAIM IS 295-295.95 (SCHIZOPHRENIA).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X890","DENY 90935-90940 (HEMODIALYSIS) WHEN BILLED AND THE ONLY DIAGNOSIS ON THE CLAIM IS SCHIZOPHRENIA.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X891","DIABETES SCREENING TESTS BILLED WITH DIAGNOSIS Z131 ARE LIMITED TO ONE PER YEAR OR ONE EVERY SIX MONTHS WITH MODIFIER TS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y891","DIABETES SCREENING TESTS BILLED WITH DIAGNOSIS Z131 ARE LIMITED TO ONE PER YEAR OR ONE EVERY SIX MONTHS WITH MODIFIER TS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y892","APPLYING PURCHASE PRICE BASED ON 10 MONTH RENTAL POLICY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X892","APPLYING PURCHASE PRICE BASED ON 10 MONTH RENTAL POLICY.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X893","ADVANCED KNEE, ANKLE AND FOOT PROSTHETICS ARE DENIED UNLESS BILLED WITH K0-K4 FUNCTIONAL MODIFIERS.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y893","ADVANCED KNEE, ANKLE AND FOOT PROSTHETICS ARE DENIED UNLESS BILLED WITH K0-K4 FUNCTIONAL MODIFIERS.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y894","NEW PATIENT VISITS ARE DENIED WHEN ANY SERVICE HAS PREVIOUSLY BEEN BILLED BY SAME FACILITY WITHIN THE LAST 3 YEARS FOR TOB 12X, 13X, 14X, 71X, 72X, 73X OR 79X. SEE CLAIM NUMBER IN HISTORY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X894","NEW PATIENT VISITS ARE DENIED WHEN ANY SERVICE HAS PREVIOUSLY BEEN BILLED BY SAME FACILITY WITHIN THE LAST 3 YEARS FOR TOB 12X, 13X, 14X, 71X, 72X, 73X OR 79X. SEE CLAIM NUMBER IN HISTORY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X895","E&M SERVICES ARE DENIED WHEN BILLED ON SAME DOS AS THERAPEUTIC APHERESIS SERVICES .","N20","Service not payable with other service rendered on the same date.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y895","E&M SERVICES ARE DENIED WHEN BILLED ON SAME DOS AS THERAPEUTIC APHERESIS SERVICES .","N20","Service not payable with other service rendered on the same date.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y896","A MAXIMUM OF 40 OCCURRENCES OF CPT 86003 (ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN) ARE ALLOWED PER YEAR.","N435","Exceeds number/frequency approved /allowed within time period without support documentation.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["X896","A MAXIMUM OF 40 OCCURRENCES OF CPT 86003 (ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN) ARE ALLOWED PER YEAR.","N435","Exceeds number/frequency approved /allowed within time period without support documentation.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["X897","ANTEPARTUM CARE BY SAME PROVIDER GROUP","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y897","ANTEPARTUM CARE BY SAME PROVIDER GROUP","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y898","SPECIAL SERVICES BY EMERGENCY MEDICINE PROVIDER","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X898","SPECIAL SERVICES BY EMERGENCY MEDICINE PROVIDER","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X899","EXTERNAL COUNTERPULSATION (ECP) FOR SEVERE ANGINA - 1","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y899","EXTERNAL COUNTERPULSATION (ECP) FOR SEVERE ANGINA - 1","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y9","THE OTHER DIAGNOSIS IS A DUPLICATE OF THE SECONDARY DIAGNOSIS","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X9","THE OTHER DIAGNOSIS IS A DUPLICATE OF THE SECONDARY DIAGNOSIS","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X90","PARTIAL HOSPITALIZATION CONDITION CODE 41 NOT APPROVED FOR TYPE OF BILL","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y900","ANNUAL DEPRESSION SCREENING (G0444)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X900","ANNUAL DEPRESSION SCREENING (G0444)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X901","EXTERNAL COUNTERPULSATION (ECP) FOR SEVERE ANGINA - 2","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y901","EXTERNAL COUNTERPULSATION (ECP) FOR SEVERE ANGINA - 2","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y902","IV HOME INFUSION WILL BE DENIED WHEN BILLED WITH MODIFIER SH OR SJ BUT THE CODE HAS NOT BEEN PREVIOUSLY BILLED FOR THE SAME DATE WITH SAME MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X902","IV HOME INFUSION WILL BE DENIED WHEN BILLED WITH MODIFIER SH OR SJ BUT THE CODE HAS NOT BEEN PREVIOUSLY BILLED FOR THE SAME DATE WITH SAME MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X903","DME MODIFIER IS SUBJECT TO PERCTANGE OF THE ALLOWED PURCHASE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y903","DME MODIFIER IS SUBJECT TO PERCTANGE OF THE ALLOWED PURCHASE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y904","REIMBURSEMENT FOR AN ASSISTANT SURGEON WHEN BILLED BY THE PRIMARY SURGEON WILL BE DENIED.","N450","Covered only when performed by the primary treating physician or the designee.","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X904","REIMBURSEMENT FOR AN ASSISTANT SURGEON WHEN BILLED BY THE PRIMARY SURGEON WILL BE DENIED.","N450","Covered only when performed by the primary treating physician or the designee.","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X905","STATUS INDICATOR N - ITEMS AND SERVICES PACKAGED INTO APC RATES","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y905","STATUS INDICATOR N - ITEMS AND SERVICES PACKAGED INTO APC RATES","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","44","Prompt-pay discount."]
["Y906","PROCEDURE IS UNRELATED TO THE PRINCIPAL DIAGNOSIS  (APR-DRG)","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X906","PROCEDURE IS UNRELATED TO THE PRINCIPAL DIAGNOSIS  (APR-DRG)","MA63","Missing/incomplete/invalid principal diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X907","IF A PROVIDER SPECIALTY OTHER THAN 69 (CLINICAL LABORATORY-BILLING INDEPENDENTLY) BILLS A CLAIM WITH A POS 81 (INDEPENDENT LABORATORY) IT WILL BE DENIED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y907","IF A PROVIDER SPECIALTY OTHER THAN 69 (CLINICAL LABORATORY-BILLING INDEPENDENTLY) BILLS A CLAIM WITH A POS 81 (INDEPENDENT LABORATORY) IT WILL BE DENIED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y908","NDC BILLED IS NOT IN THE PROPER FORMAT.  THE NDC MUST BE 11 DIGITS. (LINE LEVEL DENIAL)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X908","NDC BILLED IS NOT IN THE PROPER FORMAT.  THE NDC MUST BE 11 DIGITS. (LINE LEVEL DENIAL)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X909","NDC BILLED IS NOT IN THE PROPER FORMAT.  THE NDC MUST BE 11 DIGITS. (CLAIM LEVEL DENIAL)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y909","NDC BILLED IS NOT IN THE PROPER FORMAT.  THE NDC MUST BE 11 DIGITS. (CLAIM LEVEL DENIAL)","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X91","SERVICE IS NOT SEPARATELY PAYABLE","N390","This service/report cannot be billed separately.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X910","DISCREPANCY IN COVERED DAYS (VALUE CODE 80)  AND UNITS BILLED ON ROOM AND BOARD REVENUE CODES.","MA32","Missing/incomplete/invalid number of covered days during the billing period.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y910","DISCREPANCY IN COVERED DAYS (VALUE CODE 80)  AND UNITS BILLED ON ROOM AND BOARD REVENUE CODES (0100-0219) [{1}].","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y911","DASA CLAIM REQUIRES A VALID REVENUE CODE/HCPCS COMBINATION.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X911","DASA CLAIM REQUIRES A VALID REVENUE CODE/HCPCS COMBINATION.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X912","PER HFS''S MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS  BILLED FOR PROCEDURE EXCEED THE ALLOWED UNITS .","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["Y912","PER HFS'S MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS  BILLED FOR PROCEDURE EXCEED THE ALLOWED UNITS .","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y913","VALUE CODE IS REQUIRED FOR PATIENTS LESS THAN 14 DAYS OLD.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X913","VALUE CODE IS REQUIRED FOR PATIENTS LESS THAN 14 DAYS OLD.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X914","CODE SHOULD BE MANUALLY PRICED WITH APPROPRIATE METHOD; 75% MSRP/ 120% COST.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","44","Prompt-pay discount."]
["Y914","CODE SHOULD BE MANUALLY PRICED WITH APPROPRIATE METHOD; 75% MSRP/ 120% COST.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","44","Prompt-pay discount."]
["Y915","CONDITION CODE 81 REQUIRES A DIAGNOSIS CODE SUPPORTING MEDICAL NECESSITY FOR EARLY ELECTIVE DELIVERY.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X915","CONDITION CODE 81 REQUIRES A DIAGNOSIS CODE SUPPORTING MEDICAL NECESSITY FOR EARLY ELECTIVE DELIVERY.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X916","CONDITION CODE 82 REQUIRES A DIAGNOSIS CODE SUPPORTING MEDICAL NECESSITY FOR EARLY ELECTIVE DELIVERY.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y916","CONDITION CODE 82 REQUIRES A DIAGNOSIS CODE SUPPORTING MEDICAL NECESSITY FOR EARLY ELECTIVE DELIVERY.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y917","REVENUE CODE MUST BE BILLED WITH PROCEDURE CODE.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X917","REVENUE CODE MUST BE BILLED WITH PROCEDURE CODE.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X918","REVENUE CODE 905 OR 906 MAY NOT BE BILLED ON THE SAME DOS AS REVENUE CODE 513 â\u0080\u0093 CLINIC-PSYCHIATRIC CLINIC.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y918","REVENUE CODE 905 OR 906 MAY NOT BE BILLED ON THE SAME DOS AS REVENUE CODE 513 â\u0080\u0093 CLINIC-PSYCHIATRIC CLINIC.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y919","PROCEDURE CODE A0422 CANNOT BE BILLED WITH TRANSPORT CODES A0426, A0427, OR A0433.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X919","PROCEDURE CODE A0422 CANNOT BE BILLED WITH TRANSPORT CODES A0426, A0427, OR A0433.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X92","REVENUE CENTER REQUIRES HCPCS","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y920","DME RENTAL EXCEEDS THE MAXIMUM ALLOWED MONTHLY RENTAL CAP.","N370","Billing exceeds the rental months covered/approved by the payer.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X920","DME RENTAL EXCEEDS THE MAXIMUM ALLOWED MONTHLY RENTAL CAP.","N370","Billing exceeds the rental months covered/approved by the payer.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X921","PER CMS GUIDELINES, THE PRESENCE OF MODIFIER INDICATES THAT ONLY ASSISTANT SURGERY COMPONENT SHOULD BE REIMBURSED AT  (KENTUCKY MCD MODIFIER AS IS REDUCED @ 16%)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","44","Prompt-pay discount."]
["Y921","PER CMS GUIDELINES, THE PRESENCE OF MODIFIER INDICATES THAT ONLY ASSISTANT SURGERY COMPONENT SHOULD BE REIMBURSED AT  (KENTUCKY MCD MODIFIER AS IS REDUCED @ 16%)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","44","Prompt-pay discount."]
["Y922","AMBULATORY EEG WILL BE DENIED WHEN A RESTING EEG HAS NOT BEEN BILLED BY ANY PROVIDER ON THE SAME DAY OR WITHIN THE PAST 12 MONTHS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X922","AMBULATORY EEG WILL BE DENIED WHEN A RESTING EEG HAS NOT BEEN BILLED BY ANY PROVIDER ON THE SAME DAY OR WITHIN THE PAST 12 MONTHS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X923","ANTEPARTUM SERVICES BILLED WITH A DOS UP TO ONE WEEK FOLLOWING A DELIVERY WILL BE DENIED (EXCEPT MULTIPLE GESTATION).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y923","ANTEPARTUM SERVICES BILLED WITH A DOS UP TO ONE WEEK FOLLOWING A DELIVERY WILL BE DENIED (EXCEPT MULTIPLE GESTATION).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y924","INITIAL INPATIENT HOSPITAL VISIT WILL BE DENIED IF ANY TYPE OF INPATIENT VISIT HAS BEEN BILLED IN THE PREVIOUS WEEK BY THE SAME PROVIDER GROUP AND SPECIALTY, AND AN INPATIENT DISCHARGE VISIT HAS NOT ALSO BEEN BILLED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X924","INITIAL INPATIENT HOSPITAL VISIT WILL BE DENIED IF ANY TYPE OF INPATIENT VISIT HAS BEEN BILLED IN THE PREVIOUS WEEK BY THE SAME PROVIDER GROUP AND SPECIALTY, AND AN INPATIENT DISCHARGE VISIT HAS NOT ALSO BEEN BILLED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X925","SERVICE IS NOT COVERED FOR URGENT CARE PROVIDER.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y925","SERVICE IS NOT COVERED FOR URGENT CARE PROVIDER.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y926","PEAK EXPIRATORY FLOW RATE BILLED WITH E/M OR PHYSICIAN SERVICE AND WITHOUT A DISTINCT SERVICES MODIFIER APPENDED TO EITHER CODE WILL BE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X926","PEAK EXPIRATORY FLOW RATE BILLED WITH E/M OR PHYSICIAN SERVICE AND WITHOUT A DISTINCT SERVICES MODIFIER APPENDED TO EITHER CODE WILL BE DENIED.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X928","RADIOLOGY CODES WITH A TC MODIFIER PAYMENT","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X93","SERVICE ON SAME DAY AS INPATIENT PROCEDURE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","60","Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services."]
["X930","INPATIENT CLAIMS REQUIRE VALID ROOM AND BOARD REVENUE CODES.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X932","LIMITS 552 UNITS PER MONTH-S9122","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X933","THE PROCEDURE WAS PRICED ACCORDING TO PARTIAL HOSPITALIZATION APPROXIMATION.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X934","REVENUE CODES 510-529, OR ANY SUCCESSOR CODES, SHALL NOT BE REIMBURSED, UNLESS THERE IS A CONTRACTUAL REQUIREMENT TO DO SO.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X935","DME CODE BILLED WITHOUT A MODIFIER.","","","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X936","INTENSIVE BEHAVIORIAL THERAPY (IBT) FOR CARDIOVASCULAR DISEASE (CVD) (G0446)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X937","PREVENTIVE AND SCREENING SERVICES - PROCEDURE FREQUENCY - 2","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X938","PREVENTIVE AND SCREENING SERVICES - PROCEDURE FREQUENCY - 3","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X939","PATIENT IS INCARCERATED","N30","Patient ineligible for this service.","CO","Contractual Obligations","258","Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service."]
["X94","NON-COVERED UNDER ANY MEDICARE OUTPATIENT BENEFIT, BASED ON STATUTORY EXCLUSION","N584","Not covered based on the insured's noncompliance with policy or statutory conditions.","CO","Contractual Obligations","95","Plan procedures not followed."]
["X940","THIS PROCEDURE CODE INDICATES THAT MULTIPLE SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X941","THIS PROCEDURE CODE INDICATES THAT MULTIPLE SURGERY SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","59","Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X942","THIS PROCEDURE CODE NDICATES THAT MULTIPLE DIAGNOSTIC RADIOLOGY SERVICES WERE PERFORMED. PER CMS, A REDUCTION OF APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X943","THIS PROCEDURE CODE INDICATES THAT MULTIPLE DIAGNOSTIC CARDIOVASCULAR SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X944","THIS PROCEDURE CODE INDICATES THAT MULTIPLE DIAGNOSTIC OPHTHALMOLOGY SERVICES WERE PERFORMED. PER CMS, A REDUCTION APPLIES FOR THIS LINE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X946","THIS PROCEDURE CODE IS A BASE ENDOSCOPIC PROCEDURE BILLED WITH OTHER ENDOSCOPIC PROCEDURES AND IS NOT ELLIGIBLE FOR ADDITIONAL REIMBURSEMENT.","","","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X947","TAXONOMY FOR NPI ON THIS CLAIM IS NOT COVERED BY MEDICARE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X948","PER CCI GUIDELINES (INSTITUTIONAL), PROCEDURE CODE HAS BEEN BILLED OUT OF SEQUENCE WITH PROCEDURE CODE ON CLAIM NUMBER IN HISTORY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X949","PER CCI GUIDELINES (PHYSICIAN), PROCEDURE CODE HAS BEEN BILLED OUT OF SEQUENCE WITH PROCEDURE CODE ON CLAIM NUMBER IN HISTORY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X95","MULTIPLE OBSERVATIONS OVERLAP IN TIME (INACTIVE)","N443","Missing/incomplete/invalid total time or begin/end time.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X950","INVALID NDC TO PROCEDURE CODE COMBINATION.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X952","A MULTIPLE PROCEDURE REDUCTION OF APPLIES TO THE PROCEDURE CODE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["X953","AN NDC CODE IS REQUIRED WITH THIS PROCEDURE CODE.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y953","AN NDC CODE IS REQUIRED WITH THIS PROCEDURE CODE.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y954","THIS NDC IS NOT ON FILE. PLEASE VERIFY THAT THE NDC WAS FILED CORRECTLY.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X954","THIS NDC IS NOT ON FILE. PLEASE VERIFY THAT THE NDC WAS FILED CORRECTLY.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X955","DISTINCT SERVICE MODIFIER IS NOT ALLOWED WITH THIS CPT.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y955","DISTINCT SERVICE MODIFIER IS NOT ALLOWED WITH THIS CPT.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y956","E/M SERVICES BILLED WITH THE SAME DIAGNOSIS GROUP, AND WITHIN THE 10- OR 90-DAY GLOBAL PERIOD OF A MINOR OR MAJOR GLOBAL SURGERY ARE DENIED (SEE CLAIM IN HISTORY).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X956","E/M SERVICES BILLED WITH THE SAME DIAGNOSIS GROUP, AND WITHIN THE 10- OR 90-DAY GLOBAL PERIOD OF A MINOR OR MAJOR GLOBAL SURGERY ARE DENIED (SEE CLAIM IN HISTORY).","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X957","E/M SERVICE BILLED WITH PULMONARY FUNCTION TESTING WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y957","E/M SERVICE BILLED WITH PULMONARY FUNCTION TESTING WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y958","CPT 99477 IS DENIED WHEN NO NEONATAL CLAIMS WERE FOUND IN HISTORY WITH THIS ADMIT DATE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X958","CPT 99477 IS DENIED WHEN NO NEONATAL CLAIMS WERE FOUND IN HISTORY WITH THIS ADMIT DATE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X959","G0442 OR G0443 IS DENIED WHEN PROVIDER SPECIALTY IS NOT GENERAL PRACTICE, FAMILY PRACTICE, INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, PEDIATRIC MEDICINE, GERIATRIC MEDICINE, CERTIFIED NURSE MIDWIFE, NURSE PRACTITIONER, CERTIFIED CLINICAL NURSE SPECIALIST, OR PHYSICIAN ASSISTANT.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y959","G0442 OR G0443 IS DENIED WHEN PROVIDER SPECIALTY IS NOT GENERAL PRACTICE, FAMILY PRACTICE, INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, PEDIATRIC MEDICINE, GERIATRIC MEDICINE, CERTIFIED NURSE MIDWIFE, NURSE PRACTITIONER, CERTIFIED CLINICAL NURSE SPECIALIST, OR PHYSICIAN ASSISTANT.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X96","OBSERVATION DOES NOT MEET MINIMUM HOURS, QUALIFYING DIAGNOSES, AND/OR â\u0080\u0098Tâ\u0080\u0099 PROCEDURE CONDITIONS","N443","Missing/incomplete/invalid total time or begin/end time.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X960","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, TWIN PREGNANCY HAS A MAX UNIT RESTRICTION OF 2 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y960","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, TWIN PREGNANCY HAS A MAX UNIT RESTRICTION OF 2 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y961","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, TRIPLET PREGNANCY HAS A MAX UNIT RESTRICTION OF 3 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X961","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, TRIPLET PREGNANCY HAS A MAX UNIT RESTRICTION OF 3 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X962","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, QUADRUPLET/MULTIPLE PREGNANCY HAS A MAX UNIT RESTRICTION OF 4 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y962","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, QUADRUPLET/MULTIPLE PREGNANCY HAS A MAX UNIT RESTRICTION OF 4 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y963","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, UNIT RESTRICTION FOR ULTRASOUNDS WITH TRIPLET PREGNANCY IS 2 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X963","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, UNIT RESTRICTION FOR ULTRASOUNDS WITH TRIPLET PREGNANCY IS 2 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X964","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, UNIT RESTRICTION FOR ULTRASOUNDS WITH QUADRUPLET PREGNANCY IS 3 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y964","WHEN THE DIAGNOSIS IS MULTIPLE GESTATION, UNIT RESTRICTION FOR ULTRASOUNDS WITH QUADRUPLET PREGNANCY IS 3 PER DAY.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y965","G0442 OR G0443 IS DENIED WHEN THE POS IS NOT 11, 22, 49, 50, 71 OR 72.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X965","G0442 OR G0443 IS DENIED WHEN THE POS IS NOT 11, 22, 49, 50, 71 OR 72.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X966","G0442 IS DENIED WHEN BILLED BY ANY PROVIDER MORE THAN (1) UNIQUE VISIT PER YEAR.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y966","G0442 IS DENIED WHEN BILLED BY ANY PROVIDER MORE THAN (1) UNIQUE VISIT PER YEAR.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y967","G0443 IS DENIED WHEN WHEN BILLED BY ANY PROVIDER MORE THAN ONCE PER DATE OF SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X967","G0443 IS DENIED WHEN WHEN BILLED BY ANY PROVIDER MORE THAN ONCE PER DATE OF SERVICE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X968","G0443 IS DENIED WHEN WHEN BILLED BY ANY PROVIDER MORE THAN FOUR (4) UNIQUE VISITS PER YEAR.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y968","G0443 IS DENIED WHEN WHEN BILLED BY ANY PROVIDER MORE THAN FOUR (4) UNIQUE VISITS PER YEAR.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y969","NUCLEAR MEDICINE PROCEDURES BILLED WITHOUT A RADIOPHARMACEUTICAL IMAGING AGENT ARE DENIED WITH BILL TYPE 0120-012Z, 0130-013Z OR 0140-014Z.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X969","NUCLEAR MEDICINE PROCEDURES BILLED WITHOUT A RADIOPHARMACEUTICAL IMAGING AGENT ARE DENIED WITH BILL TYPE 0120-012Z, 0130-013Z OR 0140-014Z.","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X97","CODES G0378 AND G0379 ONLY ALLOWED WITH BILL TYPE 13X OR 85X","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y970","SERVICES THAT ARE INAPPROPRIATELY BILLED WITH ANATOMICAL MODIFIER WILL BE DENIED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X970","SERVICES THAT ARE INAPPROPRIATELY BILLED WITH ANATOMICAL MODIFIER WILL BE DENIED.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X971","REMOVE MODIFIER 26 AND TC FROM A PROCEDURE WHEN THE PROFESSIONAL/TECHNICAL COMPONENT CONCEPT DOES NOT APPLY.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y971","REMOVE MODIFIER 26 AND TC FROM A PROCEDURE WHEN THE PROFESSIONAL/TECHNICAL COMPONENT CONCEPT DOES NOT APPLY.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y972","MODIFIER IS INAPPROPRIATELY BILLED BY A PROFESSIONAL PROVIDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X972","MODIFIER IS INAPPROPRIATELY BILLED BY A PROFESSIONAL PROVIDER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X973","DRUGS AND BIOLOGICALS ARE DENIED WHEN BILLED WITHOUT AN APPROVED ASC SURGICAL PROCEDURE FOR CLAIMS SUBMITTED WITH POS 24.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y973","DRUGS AND BIOLOGICALS ARE DENIED WHEN BILLED WITHOUT AN APPROVED ASC SURGICAL PROCEDURE FOR CLAIMS SUBMITTED WITH POS 24.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y974","RADIOLOGY SERVICES ARE DENIED WHEN BILLED WITHOUT AN APPROVED ASC SURGICAL PROCEDURE ON CLAIMS WITH POS 24.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X974","RADIOLOGY SERVICES ARE DENIED WHEN BILLED WITHOUT AN APPROVED ASC SURGICAL PROCEDURE ON CLAIMS WITH POS 24.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X975","90-DAY SURGICAL PROCEDURES ARE DENIED WHEN BILLED WITHOUT MODIFIER 54 BY AN EMERGENCY MEDICINE PHYSICIAN IN THE EMERGENCY ROOM SETTING (POS 23).","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y975","90-DAY SURGICAL PROCEDURES ARE DENIED WHEN BILLED WITHOUT MODIFIER 54 BY AN EMERGENCY MEDICINE PHYSICIAN IN THE EMERGENCY ROOM SETTING (POS 23).","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y976","LABORATORY SERVICES ARE DENIED WHEN BILLED IN PLACE OF SERVICE 21, 22, 23, 24 BY A PROVIDER WITH A SPECIALTY OTHER THAN LABORATORY, PATHOLOGY, DERMATOPATHOLOGY, OR GENETIC","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X976","LABORATORY SERVICES ARE DENIED WHEN BILLED IN PLACE OF SERVICE 21, 22, 23, 24 BY A PROVIDER WITH A SPECIALTY OTHER THAN LABORATORY, PATHOLOGY, DERMATOPATHOLOGY, OR GENETIC","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X977","85060 IS DENIED WHEN NOT BILLED IN POS 21,22,23,51,52,61 OR 81.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y977","85060 IS DENIED WHEN NOT BILLED IN POS 21,22,23,51,52,61 OR 81.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y978","CPT G0443 IS DENIED WHEN G0442 HAS NOT BEEN BILLED IN THE PREVIOUS YEAR.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X978","CPT G0443 IS DENIED WHEN G0442 HAS NOT BEEN BILLED IN THE PREVIOUS YEAR.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X979","CARE PLAN OVERSIGHT SERVICES WHEN BILLED WITHIN THE SAME CALENDAR MONTH OF A MONTHLY ESRD SERVICES CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y979","CARE PLAN OVERSIGHT SERVICES WHEN BILLED WITHIN THE SAME CALENDAR MONTH OF A MONTHLY ESRD SERVICES CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X98","MULTIPLE CODES FOR THE SAME SERVICE","","","CO","Contractual Obligations","P14","The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only."]
["X980","G0008, G0009, G0010 BILLED WITHOUT THE APPROPRIATE, CORRESPONDING VACCINE CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y980","G0008, G0009, G0010 BILLED WITHOUT THE APPROPRIATE, CORRESPONDING VACCINE CODE WILL BE DENIED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y981","TYPE OF BILL 033X IS NO LONGER VALID FOR MEDICARE, EFFECTIVE OCTOBER 1, 2013","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X981","TYPE OF BILL 033X IS NO LONGER VALID FOR MEDICARE, EFFECTIVE OCTOBER 1, 2013","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X982","BLANK DRG","N208","Missing/incomplete/invalid DRG code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y982","BLANK DRG","N208","Missing/incomplete/invalid DRG code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y983","CLAIMS CONTAINING A MIXTURE OF ADMINISTRATIVE DAYS AND ANY OTHER REVENUE CODE WILL BE DENIED.","N658","The billed service(s) are not considered medical expenses.","CO","Contractual Obligations","212","Administrative surcharges are not covered"]
["X983","CLAIMS CONTAINING A MIXTURE OF ADMINISTRATIVE DAYS AND ANY OTHER REVENUE CODE WILL BE DENIED.","N658","The billed service(s) are not considered medical expenses.","CO","Contractual Obligations","212","Administrative surcharges are not covered"]
["X984","MEDI-CAL DOES NOT ALLOW ADDITIONAL REVENUE CODES FOR REHABILITATION CLAIMS. REHABILITATION REVENUE CODE/COMBINATIONS ARE ALLOWED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y984","MEDI-CAL DOES NOT ALLOW ADDITIONAL REVENUE CODES FOR REHABILITATION CLAIMS. REHABILITATION REVENUE CODE/COMBINATIONS ARE ALLOWED.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y985","CLAIM DOES NOT CONTAIN THE APPROPRIATE ER AND OBSERVATION AND PSYCHIATRIC CLINIC SERVICES FOR ILLINOIS MEDICAID.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X985","CLAIM DOES NOT CONTAIN THE APPROPRIATE ER AND OBSERVATION AND PSYCHIATRIC CLINIC SERVICES FOR ILLINOIS MEDICAID.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X986","DISCREPANCY IN SERVICE DATES AND UNITS BILLED ON REIMBURSABLE DASA PROCEDURE CODE.","N345","Date range not valid with units submitted.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y986","DISCREPANCY IN SERVICE DATES AND UNITS BILLED ON REIMBURSABLE DASA PROCEDURE CODE.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y987","DASA CLAIM REQUIRES BILL TYPE 86X OR 89X.  BILL TYPE ON CLAIM IS INVALID.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X987","DASA CLAIM REQUIRES BILL TYPE 86X OR 89X.  BILL TYPE ON CLAIM IS INVALID.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X988","THIS REVENUE CODE REQUIRES A CPT CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y988","THIS REVENUE CODE REQUIRES A CPT CODE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y989","MAJOR PROCEDURE BILLED IN THE PROVIDER'S OFFICE WHEN ANOTHER PROVIDER HAS ALREADY BILLED THIS PROCEDURE CODE IN THE LAST 90 DAYS WILL BE DENIED.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X989","MAJOR PROCEDURE BILLED IN THE PROVIDER'S OFFICE WHEN ANOTHER PROVIDER HAS ALREADY BILLED THIS PROCEDURE CODE IN THE LAST 90 DAYS WILL BE DENIED.","M86","Service denied because payment already made for same/similar procedure within set time frame.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X99","NON-REPORTABLE FOR SITE OF SERVICE","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y990","PROVIDER BILLED A GLOBAL RADIOLOGY PROCEDURE CODE FOR A DIAGNOSTIC TEST WITH A PLACE OF SERVICE OTHER THAN OFFICE. PLEASE RESUBMIT WITH MODIFIER 26.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X990","PROVIDER BILLED A GLOBAL RADIOLOGY PROCEDURE CODE FOR A DIAGNOSTIC TEST WITH A PLACE OF SERVICE OTHER THAN OFFICE. PLEASE RESUBMIT WITH MODIFIER 26.","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X991","PROCEDURES BILLED WITH MODIFIER 26 ON A UB FORM ARE DENIED, UNLESS REV CODE IS 960-989.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y991","PROCEDURES BILLED WITH MODIFIER 26 ON A UB FORM ARE DENIED, UNLESS REV CODE IS 960-989.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["Y992","NEWBORN SERVICES CPT WILL BE DENIED WHEN BILLED UNDER THE MOTHER'S SUBSCRIBER ID.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X992","NEWBORN SERVICES CPT WILL BE DENIED WHEN BILLED UNDER THE MOTHER'S SUBSCRIBER ID.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X993","DENY SERVICES INCLUDED IN THE GLOBAL OBSTETRICAL PACKAGE FOR UNCOMPLICATED MATERNITY WHEN BILLED ON THE SAME DAY AS THE DELIVERY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y993","DENY SERVICES INCLUDED IN THE GLOBAL OBSTETRICAL PACKAGE FOR UNCOMPLICATED MATERNITY WHEN BILLED ON THE SAME DAY AS THE DELIVERY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["Y994","DRG FOR THIS CLAIM IS NOT DEFINED","N208","Missing/incomplete/invalid DRG code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X994","DRG FOR THIS CLAIM IS NOT DEFINED","N208","Missing/incomplete/invalid DRG code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["X995","PER CMS GUIDELINES, THE PRESENCE OF MODIFIER INDICATES THAT ONLY ASSISTANT SURGERY COMPONENT SHOULD BE REIMBURSED AT PERCENTAGE  (KENTUCKY MCD MODIFIER AS IS REDUCED @ 16%)","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y995","PER CMS GUIDELINES, THE PRESENCE OF MODIFIER INDICATES THAT ONLY ASSISTANT SURGERY COMPONENT SHOULD BE REIMBURSED AT PERCENTAGE (KENTUCKY MCD MODIFIER AS IS REDUCED @ 16%)","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["Y996","OFFICE VISIT INITIAL CPT IS LIMITED TO ONE VISIT PER MEMBER, PER PROVIDER WITHIN THE LAST 3 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X996","OFFICE VISIT INITIAL CPT IS LIMITED TO ONE VISIT PER MEMBER, PER PROVIDER WITHIN THE LAST 3 YEARS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["X997","ESSURE IMPLANT DEVICE (A4264) IS LIMITED TO ONCE PER LIFETIME, PER MEMBER.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y997","ESSURE IMPLANT DEVICE (A4264) IS LIMITED TO ONCE PER LIFETIME, PER MEMBER.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["Y998","PROCEDURE CODE IS NOT COVERED PER HFS GUIDELINES OR NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["X998","PROCEDURE CODE IS NOT COVERED PER HFS GUIDELINES OR NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA01","ONLY ONE UNIT OF H0020 IS ALLOWED PER DAY FOR REIMBURSEMENT.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA01","ONLY ONE UNIT OF H0020 IS ALLOWED PER DAY FOR REIMBURSEMENT.","M53","Missing/incomplete/invalid days or units of service.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA02","90832-90838 MUST BE BILLED WITH MODIFIER SC WHEN BILLED WITH H0020.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA02","90832-90838 MUST BE BILLED WITH MODIFIER SC WHEN BILLED WITH H0020.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA03","ONLY ONE PSYCHIATRIC DIAGNOSTIC INTERVIEWS IS ALLOWED PER RECIPIENT, PER BILLING PROVIDER, PER ROLLING 12-MONTH PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA03","ONLY ONE PSYCHIATRIC DIAGNOSTIC INTERVIEWS IS ALLOWED PER RECIPIENT, PER BILLING PROVIDER, PER ROLLING 12-MONTH PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA04","PROCEDURE CODE IS COVERED, BUT PROVIDER TAXONOMY IS NOT APPROPRIATE TO BILL SERVICE.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA04","CLAIM LINE IS NOT BILLED IN ACCORDANCE WITH HFS GUIDELINES. REBILL THE CLAIM WITH AN APPROPRIATE BILLABLE CPT/HCPCS FOR THE PROVIDER OR CORRECT THE BILLING/RENDERING PROVIDER","","","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA05","INAPPROPRIATE SPECIFICATION OF BILATERAL PROCEDURE","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA05","INAPPROPRIATE SPECIFICATION OF BILATERAL PROCEDURE","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA07","THIS PROVIDER SPECIALTY (261QR0200X - RADIOLOGY CLINIC) IS REQUIRED TO BILL ON HCFA","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA07","THIS PROVIDER SPECIALTY (261QR0200X - RADIOLOGY CLINIC) IS REQUIRED TO BILL ON HCFA","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA08","SUBMIT CHARGES TO MEDICAID FFS PROGRAM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA08","SUBMIT CHARGES TO MEDICAID FFS PROGRAM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA09","PER HFS'S MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS BILLED FOR THE PROCEDURE EXCEED THE ALLOWED UNITS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA09","PER HFS'S MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS BILLED FOR THE PROCEDURE EXCEED THE ALLOWED UNITS.","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA11","PROVIDER IS NOT ELIGIBLE TO BILL NON-OTP PROCEDURE CODE.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA11","PROVIDER IS NOT ELIGIBLE TO BILL NON-OTP PROCEDURE CODE.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA12","NON-OTP PROVIDER IS NOT ELIGIBLE TO BILL PROCEDURE H0020.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA12","NON-OTP PROVIDER IS NOT ELIGIBLE TO BILL PROCEDURE H0020.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA13","ONE OF THE LINE ITEM SERVICE DATES (ITEMSERVICEDATE) PROVIDED IS NOT VALID.","N64","The 'from' and 'to' dates must be different.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA13","ONE OF THE LINE ITEM SERVICE DATES (ITEMSERVICEDATE) PROVIDED IS NOT VALID.","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA14","PACKAGED SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA14","PACKAGED SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA15","SERVICE DATE IS OUTSIDE OF ACCEPTABLE DATE OF SERVICE","N64","The 'from' and 'to' dates must be different.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA15","SERVICE DATE IS OUTSIDE OF ACCEPTABLE DATE OF SERVICE","N64","The 'from' and 'to' dates must be different.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA16","CBSA CANNOT BE DETERMINED FOR THIS CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA16","CBSA CANNOT BE DETERMINED FOR THIS CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA17","RATE FOR THIS CLAIM CANNOT BE DETERMINED","","","CO","Contractual Obligations","147","Provider contracted/negotiated rate expired or not on file."]
["YA17","ESRD RATE FOR THIS CLAIM CANNOT BE DETERMINED","","","CO","Contractual Obligations","147","Provider contracted/negotiated rate expired or not on file."]
["YA18","INVALID PARTIAL EPISODE PAYMENT INDICATOR","M56","Missing/incomplete/invalid payer identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA18","INVALID PARTIAL EPISODE PAYMENT INDICATOR","M56","Missing/incomplete/invalid payer identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA19","INVALID INITIAL PAYMENT INDICATOR","M56","Missing/incomplete/invalid payer identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA19","INVALID INITIAL PAYMENT INDICATOR","M56","Missing/incomplete/invalid payer identifier.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA20","INITIAL HALF PAYMENT WILL BE ZERO","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA20","INITIAL HALF PAYMENT WILL BE ZERO","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA21","PROVIDER SPECIFIC RATE ZERO WHEN BLENDED PAY REQUESTED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA21","PROVIDER SPECIFIC RATE ZERO WHEN BLENDED PAY REQUESTED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA22","PATIENT HEIGHT MUST BE GREATER THAN 0.","N359","Missing/incomplete/invalid height.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA22","PATIENT HEIGHT MUST BE GREATER THAN 0.","N359","Missing/incomplete/invalid height.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA23","PATIENT WEIGHT MUST BE GREATER THAN 0.","N207","Missing/incomplete/invalid weight.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA23","PATIENT WEIGHT MUST BE GREATER THAN 0.","N207","Missing/incomplete/invalid weight.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA24","CLAIM CONTAINS HCPCS NOT ON THE AMBULATORY PROCEDURE LISTING (APL) THAT MUST BILLED FEE FOR SERVICE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA24","CLAIM CONTAINS HCPCS NOT ON THE AMBULATORY PROCEDURE LISTING (APL) THAT MUST BILLED FEE FOR SERVICE","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA25","INSTITUTIONAL CLAIM WAS REGROUPED BASED ON POLICY. FINAL APR-DRG WAS CHANGED.","","","CO","Contractual Obligations","44","Prompt-pay discount."]
["YA26","EP MODIFIER IS REQUIRED FOR EPSDT CODES","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA26","EP MODIFIER IS REQUIRED FOR EPSDT CODES","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA27","OUTPATIENT SERVICES PERFORMED THREE DAYS PRIOR TO INPATIENT ADMISSION.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA27","OUTPATIENT SERVICES PERFORMED THREE DAYS PRIOR TO INPATIENT ADMISSION.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA28","CPT/HCPCS IN PREVENTIVE SCHEDULE","","","CO","Contractual Obligations","44","Prompt-pay discount."]
["XA28","CPT/HCPCS IN PREVENTIVE SCHEDULE","","","CO","Contractual Obligations","44","Prompt-pay discount."]
["XA29","DENY TC MODIFIERS","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA29","DENY TC MODIFIERS","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA30","DME IS NOT COVERED IN PLACE OF SERVICE {0}.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA30","DME IS NOT COVERED IN PLACE OF SERVICE .","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA31","EFFECTIVE JANUARY 1, 2011, THE PURCHASE OPTION FOR CAPPED RENTAL ITEMS IS ONLY AVAILABLE FOR COMPLEX REHABILITATIVE POWER-DRIVEN WHEELCHAIRS.","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA31","EFFECTIVE JANUARY 1, 2011, THE PURCHASE OPTION FOR CAPPED RENTAL ITEMS IS ONLY AVAILABLE FOR COMPLEX REHABILITATIVE POWER-DRIVEN WHEELCHAIRS.","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA32","DME CODES IN CATEGORY CR ARE LIMITED TO 1 PER MONTH - SEE CLAIM NUMBER {0}.","N435","Exceeds number/frequency approved /allowed within time period without support documentation.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["XA32","DME CODES IN CATEGORY CR ARE LIMITED TO 1 PER MONTH - SEE CLAIM IN HISTORY.","N435","Exceeds number/frequency approved /allowed within time period without support documentation.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA34","CPT-4 CODE 74740 IS NOT REIMBURSABLE IF PERFORMED WITHIN THREE MONTHS FOLLOWING A TUBAL OCCLUSION/TRANSECTION/ LIGATION PROCEDURE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA34","CPT-4 CODE 74740 IS NOT REIMBURSABLE IF PERFORMED WITHIN THREE MONTHS FOLLOWING A TUBAL OCCLUSION/TRANSECTION/ LIGATION PROCEDURE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA35","THIS REVENUE CODE REQUIRES A SPECIFIC AGE RANGE AND/OR GENDER .","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA35","THIS REVENUE CODE REQUIRES A SPECIFIC AGE RANGE {0} AND/OR GENDER {1}.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA36","VALUE CODE {0} IS REQUIRED FOR LTC CLAIM WITH TOB/TAXONOMY COMBINATION {1}.","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA36","VALUE CODE IS REQUIRED FOR LTC CLAIM WITH TOB/TAXONOMY COMBINATION .","","","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA37","THE DIAGNOSTIC PROCEDURE CODE BILLED BY A PHYSICIAN REQUIRES A 26 MODIFIER. MODIFIER 26 WAS ADDED TO THIS PROCEDURE. PAYMENT MAY BE REDUCED TO PROFESSIONAL COMPONENT.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA37","THE DIAGNOSTIC PROCEDURE CODE {0} BILLED BY A PHYSICIAN REQUIRES A 26 MODIFIER. MODIFIER 26 WAS ADDED TO THIS PROCEDURE. PAYMENT MAY BE REDUCED TO PROFESSIONAL COMPONENT.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA38","COVERAGE IS FOR 09-QUALIFIED MEDICARE BENEFICIARY (QMB) ONLY.","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA38","COVERAGE IS FOR 09-QUALIFIED MEDICARE BENEFICIARY (QMB) ONLY.","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA39","LTC DIRECT BILLING GUIDELINES REQUIRES ADMIT DATE AND ADMIT HOUR BE PRESENT ON THE CLAIM.","N46","Missing/incomplete/invalid admission hour.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA39","LTC DIRECT BILLING GUIDELINES REQUIRES ADMIT DATE AND ADMIT HOUR BE PRESENT ON THE CLAIM.","N46","Missing/incomplete/invalid admission hour.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA40","PROCEDURE CODE 90899 IS ALL-INCLUSIVE AND ENCOMPASSES BOTH THE PROFESSIONAL AND FACILITY CHARGES FOR IOP SERVICES FOR A SINGLE DOS.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA40","PROCEDURE CODE 90899 IS ALL-INCLUSIVE AND ENCOMPASSES BOTH THE PROFESSIONAL AND FACILITY CHARGES FOR IOP SERVICES FOR A SINGLE DOS.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA43","AGE DIAGNOSIS RESTRICTION - INFANT (< 1 YEAR)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA43","AGE DIAGNOSIS RESTRICTION - INFANT (< 1 YEAR)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA44","AGE DIAGNOSIS RESTRICTION - CHILD (< 19 YEARS)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA44","AGE DIAGNOSIS RESTRICTION - CHILD (< 19 YEARS)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA45","AGE DIAGNOSIS RESTRICTION - ADOLESCENT (10 - 19 YEARS)","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA45","AGE DIAGNOSIS RESTRICTION - ADOLESCENT (10 - 19 YEARS)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA46","AGE DIAGNOSIS RESTRICTION - ADULT (20+ YEARS)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA46","AGE DIAGNOSIS RESTRICTION - ADULT (20+ YEARS)","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA49","SMOKING CESSATION TREATMENT - FREQUENCY","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA49","SMOKING CESSATION TREATMENT - FREQUENCY","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA50","PSYCHOTHERAPY WITH MEDICAL EVALUATION AND MANAGEMENT IS NOT REIMBURSABLE FOR PROVIDER TYPE.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA50","PSYCHOTHERAPY WITH MEDICAL EVALUATION AND MANAGEMENT IS NOT REIMBURSABLE FOR PROVIDER TYPE.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA51","INTERACTIVE COMPLEXITY PROCEDURE CODE MAY NOT BE BILLED AS A STAND-ALONE CODE OR WITH INAPPROPRIATE PROCEDURE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA51","INTERACTIVE COMPLEXITY PROCEDURE CODE {0} MAY NOT BE BILLED AS A STAND-ALONE CODE OR WITH INAPPROPRIATE PROCEDURE.","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA52","BRIDGE APPOINTMENT MUST BE BILLED ON HCFA CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA52","BRIDGE APPOINTMENT MUST BE BILLED ON HCFA CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA53","BRIDGE APPOINTMENT IS LIMITED TO ONE UNIT PER HOSPITALIZATION.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA53","BRIDGE APPOINTMENT IS LIMITED TO ONE UNIT PER HOSPITALIZATION.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA54","PROCEDURE TERMINATED FOR NON-MEDICAL REASONS","","","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA54","PROCEDURE TERMINATED FOR NON-MEDICAL REASONS","N65","Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA56","THE DIAGNOSIS {0} ({1}) AND MODIFIER {2} COMBINATION ARE INAPPROPRIATE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA56","THE DIAGNOSIS AND MODIFIER COMBINATION ARE INAPPROPRIATE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA57","THE TOTAL UNITS OF EPOGEN MUST BE REPORTED USING VALUE CODE 68 AND/OR DOES NOT MATCH TOTAL UNITS BILLED.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA57","THE TOTAL UNITS OF EPOGEN MUST BE REPORTED USING VALUE CODE 68.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA60","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA60","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA61","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA61","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA62","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA62","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA63","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA63","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA64","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA64","THIS REVENUE CODE IS NOT PAYABLE ON AN OUTPATIENT CLAIM","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA65","DME SERVICE IS NOT COVERED BY CMS AS A RENTAL OR A PURCHASE WHEN THE ITEM HAS PREVIOUSLY BEEN PAID AS EITHER A RENTAL OR A PURCHASE FOR THE SAME DATE OF SERVICE. SEE HISTORICAL CLAIM .","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA65","DME SERVICE IS NOT COVERED BY CMS AS A RENTAL OR A PURCHASE WHEN THE ITEM HAS PREVIOUSLY BEEN PAID AS EITHER A RENTAL OR A PURCHASE FOR THE SAME DATE OF SERVICE. SEE HISTORICAL CLAIM .","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA66","NPWT PUMP DRESSING KITS (A6550) REIMBURSEMENT IS LIMITED TO 15 PER MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["XA66","NPWT PUMP DRESSING KITS (A6550) REIMBURSEMENT IS LIMITED TO 15 PER MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["XA67","NPWT PUMP CANISTER SETS (A7000) REIMBURSEMENT IS LIMITED TO 10 PER MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA67","NPWT PUMP CANISTER SETS (A7000) REIMBURSEMENT IS LIMITED TO 10 PER MONTH.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA68","PROFESSIONAL RADIOLOGY SERVICES BILLED BY A PROVIDER OTHER THAN AN ANESTHESIOLOGIST, CARDIOLOGIST, MULTISPECIALIST, NEUROLOGIST, PHYSICAL MEDICINE SPECIALIST, RADIOLOGIST, OR RADIATION ONCOLOGIST IN THE IP OR OP HOSPITAL SETTING WILL BE DENIED.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA68","PROFESSIONAL RADIOLOGY SERVICES BILLED BY A PROVIDER OTHER THAN AN ANESTHESIOLOGIST, CARDIOLOGIST, MULTISPECIALIST, NEUROLOGIST, PHYSICAL MEDICINE SPECIALIST, RADIOLOGIST, OR RADIATION ONCOLOGIST IN THE IP OR OP HOSPITAL SETTING WILL BE DENIED.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA69","CHIROPRACTIC SERVICE IS LIMITED TO 26 VISITS PER RECIPIENT PER 12 MONTH PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA69","CHIROPRACTIC SERVICE IS LIMITED TO 26 VISITS PER RECIPIENT PER 12 MONTH PERIOD.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["YA72","PROPER MODIFIERS NOT BILLED TO ALLOW REIMBURSEMENT FOR ASSISTANT SURGEON AT A TEFRA HOSPITAL.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA72","PROPER MODIFIERS NOT BILLED TO ALLOW REIMBURSEMENT FOR ASSISTANT SURGEON AT A TEFRA HOSPITAL.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA74","THIS PLACE OF SERVICE CODE IS NOT ELIGIBLE FOR PRIMARY CARE PHYSICIAN CLASSIFICATION.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA74","THIS PLACE OF SERVICE CODE IS NOT ELIGIBLE FOR PRIMARY CARE PHYSICIAN CLASSIFICATION.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA75","PLACE OF SERVICE CODE IS NOT ELIGIBLE FOR MID LEVEL PROVIDER CLASSIFICATION.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA75","PLACE OF SERVICE CODE IS NOT ELIGIBLE FOR MID LEVEL PROVIDER CLASSIFICATION.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA76","BILL TYPE 14X IS ONLY VALID FOR LAB TEST","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA76","BILL TYPE 14X IS ONLY VALID FOR LAB TEST","MA30","Missing/incomplete/invalid type of bill.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA85","LINE BUNDELED INTO ENCOUNTER RATE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA85","LINE BUNDELED INTO ENCOUNTER RATE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["YA86","MUST BILL WITH ENCOUNTER CODE T1015 OR S5190","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA86","MUST BILL WITH ENCOUNTER CODE T1015 OR S5190","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA87","FAMILY PLANNING DEVICES AND SERVICES MUST BE SUBMITTED ON A SEPARATE CLAIM. CANNOT COMBINE WITH OTHER NON-FAMILY PLANNING SERVICES. REBILL FAMILY PLANNING SERVICES ON ANOTHER CLAIM.","N61","Rebill services on separate claims.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["YA87","FAMILY PLANNING DEVICES AND SERVICES MUST BE SUBMITTED ON A SEPARATE CLAIM. CANNOT COMBINE WITH OTHER NON-FAMILY PLANNING SERVICES. REBILL FAMILY PLANNING SERVICES ON ANOTHER CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA91","INCORRECT MODIFIER USED FOR BEHAVORIAL HEALTH SERVICE","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA93","CPT CODE IS NOT REIMBURSABLE IN THIS PLACE OF SERVICE.","","","CO","Contractual Obligations","58","Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XA96","THE CLAIM WAS BILLED WITH AN OPERATING ROOM REVENUE CODE AND WITHOUT A ICD-10-PCS PROCEDURE CODE.","MA66","Missing/incomplete/invalid principal procedure code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA98","VALUE CODE IS REQUIRED FOR PATIENTS BELOW AGE MINIMUM.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XA99","OCCURRENCE CODE IS REQUIRED FOR LTC CLAIM WITH TOB/TAXONOMY COMBINATION .","M45","Missing/incomplete/invalid occurrence code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB01","VALUE CODE 23 IS REQUIRED ON LTC CLAIMS.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB02","PROCEDURE NOT VALID FOR SERIES BILL.","","","CO","Contractual Obligations","282","The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB03","CLAIMS SUBMITTED FOR LTC SERVICES MUST BE FOR A SINGLE MONTH OF SERVICE.","N74","Resubmit with multiple claims, each claim covering services provided in only one calendar month.","CO","Contractual Obligations","267","Claim/service spans multiple months. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["XB04","PROCEDURE CODE IS DATED OUTSIDE OF STATEMENT DATES .","N301","Missing/incomplete/invalid procedure date(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB05","MEDICATION ASSISTED TREATMENT (MAT) CODE IS REIMBURSED WITH MAXIMUM OF ONE UNIT PER EVERY SEVEN (7) CALENDAR DAYS.","N640","Exceeds number/frequency approved/allowed within time period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["XB06","HFS STATE T1015 AND S5190 CANNOT BE BILLED ON THE SAME CLAIM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB07","EFFECTIVE 1/1/2018, HFS REQUIRES LEGAL ABORTION SERVICES TO BE BILLED WITH A MODIFIER INDICATING THE REASON.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB08","INTERIM CLAIMS ARE NOT ALLOWED FOR HOSPITAL STAYS SUBJECT TO DRG PAYMENT METHODOLOGY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB26","DIAGNOSIS: THE DIAGNOSIS IS NOT TYPICAL FOR PATIENTS AGE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB27","PROCEDURE: THE PROCEDURE IS NOT TYPICAL FOR PATIENTS AGE.","","","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB28","BILLING TAXONOMY IS BLANK OR INVALID","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB40","INTERIM CLAIM MUST BE AT LEAST 30 DAYS OLD","","","CO","Contractual Obligations","152","Payer deems the information submitted does not support this length of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB41","INTERIM CLAIMS ARE NOT ALLOWED FOR HOSPITAL STAYS SUBJECT TO DRG PAYMENT METHODOLOGY","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","135","Interim bills cannot be processed."]
["XB42","PRACTITIONER BILLING ENCOUNTER CODE, NPI NOT ENROLLED AS FQHC/ERC/RHC.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB44","EACH VACCINE/TOXOID PROCEDURE CODE MUST BE IMMEDIATELY FOLLOWED BY THE APPLICABLE ADMIN CODE(S) ON THE SAME CLAIM (ADMIN CODE 90461 MUST ALWAYS BE PRECEDED BY 90460 (2-PART ADMIN) AND ADMIN CPT CODES MUST BE LISTED IN INCREASING ORDER)","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB49","THERAPY SERVICES PREVIOUSLY PAID.","","","CO","Contractual Obligations","B13","Previously paid. Payment for this claim/service may have been provided in a previous payment."]
["XB51","PROCEDURE CODE IS DATED OUTSIDE OF STATEMENT DATES .","N303","Missing/incomplete/invalid principal procedure date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB53","VACCINE RESTRICTED TO AGE 9 THROUGH 26 YEARS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB63","INTERIM CLAIMS ARE NOT ALLOWED FOR HOSPITAL STAYS SUBJECT TO DRG PAYMENT METHODOLOGY.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB74","OCCURRENCE CODE IS REQUIRED WHEN PATIENT IS EXPIRED.","M45","Missing/incomplete/invalid occurrence code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB75","A GENERAL HOSPITAL (PROV TYPE 30) ELIGIBLE FOR INPATIENT PSYCH MUST BILL WITH ONE OF THESE TAXONOMY CODES. 273R00000X (PSYCHIATRIC UNIT) AND 283Q00000X (PSYCHIATRIC HOSPITAL)","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB76","A GENERAL CARE HOSPITAL (PROV TYPE 30) NOT ENROLLED FOR IP PSYCH CAN ONLY BILL FOR 3 EMERGENCY DAYS AS GENERAL IP CARE.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB80","A PSYCH HOSPITAL (PROV TYPE 31) MUST BILL AS IP PSYCH CARE. 273R00000X (PSYCHIATRIC UNIT) AND 283Q00000X (PSYCHIATRIC HOSPITAL)","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB81","MODIFIER IS SUBJECT TO A 50% REDUCTION","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB82","DISCONTINUED PROCEDURE MODIFIER 53 REIMBURSES 25% OF ALLOWABLE","","","CO","Contractual Obligations","203","Discontinued or reduced service."]
["XB83","POSTOPERATIVE MANAGEMENT ONLY MODIFIER 55 REIMBURSES 20% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB84","STAGED OR RELATED PROCEDURE OR SERVICE BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL DURING THE POSTOPERATIVE PERIOD MODIFIER 58 REIMBURSES 70% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB85","REPEAT PROCEDURE OR SERVICE BY SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL MODIFIER 76 REIMBURSES 70% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB86","REPEAT PROCEDURE BY ANOTHER PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL MODIFIER 77 REIMBURSES 70% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB87","UNPLANNED RETURN TO THE OPERATING/PROCEDURE ROOM BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL FOLLOWING INITIAL PROCEDURE FOR A RELATED PROCEDURE DURING THE POSTOPERATIVE PERIOD MODIFIER 78 REIMBURSES 70% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB88","UNRELATED PROCEDURE OR SERVICE BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL DURING THE POSTOPERATIVE PERIOD MODIFIER 79 REIMBURSES 70% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB89","ASSISTANT SURGEON MODIFIER 80 REIMBURSES 16% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB90","MINIMUM ASSISTANT SURGEON MODIFIER 81 REIMBURSES 10% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB91","ASSISTANT SURGEON (WHEN QUALIFIED RESIDENT SURGEON NOT AVAILABLE) MODIFIER 82 REIMBURSES 20% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB92","PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR CLINICAL NURSE SPECIALIST SERVICES FOR ASSISTANT AT SURGERY MODIFIER AS REIMBURSES 16% OF ALLOWABLE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB93","ENCOUNTER CLINICS WITH BILLING PROVIDER TAXONOMY ON CLAIM CANNOT BILL IN THIS PLACE OF SERVICE.","N428","Not covered when performed in this place of service.","CO","Contractual Obligations","171","Payment is denied when performed/billed by this type of provider in this type of facility. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XB97","VACCINE RESTRICTED TO FEMALES AGE 9 THROUGH 25 YEARS.","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XB98","A $35.00 DISPENSING IS FEE ALLOWED WHEN BILLED WITH THE UD MODIFIER FOR HIGHLY EFFECTIVE BIRTH  CONTROL METHODS PURCHASED THROUGH THE 340B FEDERAL DRUG PRICING PROGRAM.","","","CO","Contractual Obligations","91","Dispensing fee adjustment."]
["XB99","A $12.00 DISPENSING FEE IS ALLOWED FOR 340B ENROLLED PROVIDERS WHEN BILLED WITH THE UD MODIFIER.","","","CO","Contractual Obligations","91","Dispensing fee adjustment."]
["OBS","Claim denies if provider bills more then 48 hours (units) of G0378 and there is no authorization","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC01","A $208.00 PER UNIT VENT ADD-ON APPLIES TO THIS SERVICE","","","CO","Contractual Obligations","91","Dispensing fee adjustment."]
["XC17","IL CODE IS SUBJECT TO A GLOBAL ADD ON OF 51.66","","","CO","Contractual Obligations","91","Dispensing fee adjustment."]
["XC18","C68 ILLOGICAL PATIENT STATUS FOR BILLING STATUS.","MA43","Missing/incomplete/invalid patient status.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC19","VALUE CODES 80 AND 81 MUST EQUAL THE ROOM & BOARD DAYS AND STATEMENT DATES.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC32","INVALID PLACE OF SERVICE CODE BILLED FOR CMHC ON DATE OF SERVICE","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC33","PROVIDER TAXONOMY IS NOT APPROPRIATE TO BILL PROCEDURE CODE","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC34","PROCEDURE CODE IS NOT APPROPRIATE TO BILL FOR PATIENT AGE","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC35","PROCEDURE CODE IS NOT APPROPRIATE TO BILL IN PLACE OF SERVICE","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC37","PROCEDURE CODE IS NOT EFFECTIVE FOR DATE OF SERVICE","N56","Procedure code billed is not correct/valid for the services billed or the date of service billed.","CO","Contractual Obligations","181","Procedure code was invalid on the date of service."]
["XC40","INVALID ADMIT DATE FOR INTERIM CLAIM","MA40","Missing/incomplete/invalid admission date.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC49","REVENUE CODE IS ONLY ALLOWED WHEN PROVIDER IS REGISTERED WITH COS","","","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC54","ANY VISIT LASTING TWO HOURS OR LESS WILL PAY AT A FLAT RATE. A VISIT LASTING OVER TWO HOURS PAYS A FLAT RATE PLUS EACH ADDITIONAL HOUR AT A REDUCED RATE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XC64","PROVIDER IS CONSIDERED A MID-LEVEL PROVIDER. PAYMENT IS REDUCED BY 25%.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["XC66","ONLY INCIDENTAL SERVICES REPORTED","N674","Not covered unless a pre-requisite procedure/service has been provided.","CO","Contractual Obligations","107","The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XC82","OCCURRENCE SPAN CODE 74 IS REQUIRED ON LTC CLAIMS WITH REVENUE CODES 0182, 0183 OR 0185","M45","Missing/incomplete/invalid occurrence code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XC83","BED RESERVE BR HAS EXCEEDED 30 DAYS FOR THE FISCAL YEAR.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["XC98","PAYMENT FOR THERAPEUTIC LEAVE SHALL NOT EXCEED 10 DAYS CONSECUTIVELY","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["XD52","REVENUE CODE 183 FOR SMHRF IS REIMBURSED AT 75% OF CURRENT FACILITY RATE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XD53","ANESTHESIA PERFORMED BY BOTH AN ANESTHESIOLOGIST AND A CRNA FOR THE SAME PROCEDURE ON THE SAME PARTICIPANT DURING A SINGLE OPERATIVE SESSION REQUIRES SUPPORTING DOCUMENTATION.","M127","Missing patient medical record for this service.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["XD54","DASA SERVICES ARE NOT ALLOWED IN THIS PLACE OF SERVICE.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XD76","SHINGLES 2 DOSE MAX IN LIFETIME","N587","Policy benefits have been exhausted.","CO","Contractual Obligations","35","Lifetime benefit maximum has been reached."]
["XD77","SHINGLES VACCINE ONLY FOR PATIENTS 50 YEARS OR OLDER","M82","Service is not covered when patient is under age 50.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XD99","DASA SERVICE IS ONLY ALLOWED IN PLACE OF SERVICE 03, 21, 22, 55, 57, AND 99.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["DMPA","DME PROCEDURE CODE REQUIRE PREAUTHRIZATION","","","CO","Contractual Obligations","197","Precertification/authorization/notification/pre-treatment absent."]
["XE00","DASA SERVICE IS ONLY ALLOWED IN PLACE OF SERVICE 03, 21, 22, 55, 57, OR 99.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE17","PSYCHIATRIC CLINIC TYPE B SERVICES MUST BE BILLED WITH REVENUE CODE 912 OR 913.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE18","FOR SERVICE DATES BEGINNING 1/1/17, ALL OBSERVATION/0762 CLAIMS RECEIVED BY THE DEPARTMENT MUST BE CODED WITH G0379 AND G0378.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE19","HCPCS MUST BE BILLED WITH REVENUE CODE 450.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE20","HCPCS MUST BE BILLED WITH REVENUE CODE 456.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE21","HCPCS MUST BE BILLED WITH REVENUE CODE 451.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE29","ENCOUNTER CODE (T1015) CANNOT BE BILLED IN THIS PLACE OF SERVICE.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE52","PROVIDER CANNOT BILL ENCOUNTER CODE T1015","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XE53","DISCREPANCY IN VALUE CODE 80 UNITS AND DASA UNITS.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XE85","HCPCS CODE DOES NOT HAVE AN ASSIGNED RATE ON THE DME SCHEDULE.  PLEASE SUBMIT THE M.S.R.P. OR MANUFACTUROR''''S INVOICE FOR THESE SERVICES.","M23","Missing invoice.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["XF05","REPAIR OF BENEFICIARY-OWNED DME EQUIPMENT OVERLAPS THE DATES OF SERVICE FOR RENTAL OF A MULTI-FUNCTION VENTILATOR.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XF10","HOSPICE VALUE CODE IS MISSING OR INVALID.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XF30","INVALID BIRTH WEIGHT","N207","Missing/incomplete/invalid weight.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XF31","GESTATIONAL AGE/BIRTH WEIGHT CONFLICT, I.E., BIRTH WEIGHT IS NOT REASONABLE FOR THE GESTATIONAL AGE OF THE BABY","N207","Missing/incomplete/invalid weight.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XF32","THIS SERVICE IS NOT BILLABLE ON THE INSTITUTIONAL CLAIM FORMAT.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XF54","CERTAIN BIOLOGICALS AND RADIOPHARMACEUTICALS CODES REQUIRE SUBMISSION OF THE ACTUAL INVOICE AMOUNT.","M23","Missing invoice.","CO","Contractual Obligations","252","An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)."]
["XF61","NPI(S) IS NOT VALID.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XF65","PERCUTANEOUS IMAGE-GUIDED LUMBAR DECOMPRESSION (PILD) PROCEDURE CODE 0275T OR G0276 ARE ONLY PAYABLE WHEN BILLED WITH THE APPROPRIATE DIAGNOSIS CODE, CONDITION CODE, MODIFIER AND 8-DIGIT NATIONAL CLINICAL TRIAL IDENTIFIER.","M64","Missing/incomplete/invalid other diagnosis.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XF66","REVIEW NON-TRANSPORT AMBULANCE CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XF68","ALLOWED AMOUNT IS GREATER THAN BILLED CHARGES.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XF74","EMERGENCY DEPARTMENT REVENUE CODE 452 OR 459 IS NOT ALLOWED WITH CURRENT HCPC CODE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XF83","HFS REQUIRES THE APPROPRIATE MODIFIER AND CONDITION CODE AH WHEN REPORTING ABORTION SERVICES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XF90","Diagnosis Z68.51 is not appropriate for ages under 2 and over 19 years.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XG01","ANOTHER E&M CODE WAS BILLED ON THE SAME DATE OF SERVICE. PLEASE ATTACH MODIFIER 25 OR SPLIT E&M CODE WITH MULTIPLE UNITS TO SEPARATE SERVICE LINES AND ATTACH MODIFIER 25.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XG32","COVERED DAYS (VALUE CODE 80) DOES NOT EQUAL THE TREATMENT DAYS REPORTED AS REVENUE CODES 821, 829, 830, 831, 839, 840, 841, 849, 850, 851, or 859","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XG43","CPT CODE MUST HAVE MODIFIER QW TO BE RECOGNIZED AS A WAIVED TEST.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XG46","ACT AND CST SERVICES MUST BE BILLED WITH AN ADDITIONAL MODIFIER INDICATING THE PRACTITIONER LEVEL DELIVERING THE UNIT(S) OF SERVICE.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XG51","HCPCS J0604 OR J0606 REQUIRES MODIFIER AX.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XG52","MODIFIER AX IS PRESENT WITHOUT HCPCS CODE J0604 OR J0606.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XG65","CLAIMS SUBMITTED WITH STUDENT TAXONOMY 390200000X DO NOT QUALIFY FOR REIMBURSEMENT.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XH06","JXXXX HCPCS CODE REQUIRES NDC TO BE PRESENT.","M119","Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XH07","IL MEDICAID CONTRACEPTIVE PILLS MUST BE BILLED WITH J8499 WITH DATES OF SERVICE ON OR AFTER JUNE 1, 2016.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XH28","THESE PHYSICIAN SERVICE CODES SHOULD BE BILLED TO PART B MAC OR DME, AS APPROPRIATE, FOR PAYMENT CONSIDERATION.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XH31","STATEMENT THROUGH DATE CANNOT BE GREATER THAN THE DATE OF DEATH ON CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XH39","HFS REQUIRES THE APPROPRIATE MODIFIER AND CONDITION CODE AH WHEN REPORTING ABORTION SERVICES.","N822","Missing procedure modifier(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XH63","IL MEDICAID CONTRACEPTIVE PILLS MUST BE BILLED WITH J8499 WITH DATES OF SERVICE ON OR AFTER JUNE 1 2016.","N431","Not covered with this procedure.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XH78","INAPPROPRIATE BILLING- BILATERAL PROCEDURE CODE BILLED > 1 UNIT","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["XH82","CLAIMS BILLED OUTSIDE OF POS 12 ARE NOT PAID","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XH87","Potentially Preventable Inpatient Readmission within 30 days","","","CO","Contractual Obligations","249","This claim has been identified as a readmission. (Use only with Group Code CO)"]
["XI07","VALUE CODE 80 IS REQUIRED WHEN REPORTING AN ESRD REVENUE CODE.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XI18","A $10 per diem add-on should be applied to single occupancy rooms for Specialized Mental Health Rehabilitation Facilities that bill with revenue code 110.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XI27","ONE SCREENING EVERY 6 MONTHS FOR MEDICARE BENEFICIARIES DIAGNOSED WITH PRE-DIABETES; LIMIT HAS BEEN REACHED","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XI29","A NON-INDIVIDUAL PROVIDER IS EXPECTED TO BE BILLING INSTITUTIONAL TYPE OF BILL {BILLTYPE}.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XI44","FEE FOR SERVICE PROVIDER IS REQUIRED TO BILL THE RENDERING PROVIDER TAXONOMY AS THE BILLING PROVIDER TAXONOMY.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","299","The billing provider is not eligible to receive payment for the service billed."]
["XI76","WHEN A PATIENT IS TRANSFERRED WITHIN A GROUP PRACTICE SETTING, A NEW PATIENT PROCEDURE CODE IS NOT TO BE USED.","N113","Only one initial visit is covered per physician, group practice or provider.","CO","Contractual Obligations","B16","New Patient' qualifications were not met."]
["XI81","CODE NOT ON AMBULATORY PROCEDURES LISTING (APL) AND IS SUBJECT TO FFS. LINE HAS BEEN CROSSWALKED TO STATUS INDICATOR A.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XI94","TAXONOMY 261QM2800X - METHADONE CLINIC CAN ONLY BILL H0020 - MEDICATION ASSISTED TREATMENT .","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XI95","METHADONE CLINICS (TAXONOMY 261QM2800X) CANNOT BILL SERVICES OTHER THAN MEDICATION ASSISTED TREATMENT (MAT) H0020.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XJ37","THIS PROVIDER IS NOT REGISTERED WITH COS 027, AND, THEREFORE, NOT ELIGIBLE FOR REIMBURSEMENT.","N180","This item or service does not meet the criteria for the category under which it was billed.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XJ76","COVID-19 RELIEF 20% INCREASE ON CODE (SUPR)","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XJ77","COVID-19 RELIEF 20% INCREASE ON CODE. (METHADONE)","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XJ78","COVID-19 RELIEF 20% INCREASE ON CODE. (CMHC/BH)","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XJ80","CONDITION CODE DR IS MANDATORY FOR INSTITUTIONAL PROVIDERS IN BILLING SITUATIONS RELATED TO COVID-19.","M44","Missing/incomplete/invalid condition code.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XJ81","COVID-19 CODE IS NOT REIMBURSABLE WHEN BILLED ON A HOSPITAL CLAIM.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XJ87","THERAPY PRICES USING EAPG METHODOLOGY EFFECTIVE 7/1/2020.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XK43","THIS CLAIM CONTAINS A VALID PSYCHIATRIC CLINIC APL, BUT THE BILLED TAXONOMY IS NOT A PSYCHIATRIC FACILITY.","","","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XK46","PROCEDURE CODE J3590 MUST BE BILLED WITH VALID ZOLGENSMA NDC","M51","Missing/incomplete/invalid procedure code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XK47","COOK COUNTY CLINICS BILLING WITH TIN 366006541 ARE NO LONGER ENROLLED AS ENCOUNTER RATE CLINICS AS OF 4/1/2020.","","","CO","Contractual Obligations","299","The billing provider is not eligible to receive payment for the service billed."]
["XK49","LTC COVID ISOLATION/QUARANTINE PEND FOR MANUAL PRICING.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XK56","WHEN SURGERY CPT IS PRESENT WITH AS MODIFIER ON A CLAIM, IT WILL PRICE AT 35% OF THE SURGICAL REIMBURSEMENT RATE.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XK60","ZOLGENSMA MUST BE BILLED WITH J3590.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XK62","OHIO MEDICAID MID-LEVEL PROVIDER, ADVANCED NURSING TAXONOMY, IS PAID AT 85%, WHEN PROVIDING SERVICES IN A HOSPITAL SETTING.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XK63","OHIO MEDICAID BI-LATERAL PROCEDURE, PAYMENT IS ADJUSTED BY 150%.","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XK68","ILLINOIS PODIATRY CLAIMS WITH NOTE CODE B ARE INITIAL VISITS ONLY COVERED ONCE PER PATIENT PER PROVIDER OR GROUP.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XK69","EFFECTIVE 7/1/2020, HOSPITALS MUST BILL SERVICES AS OUTPATIENT INSTITUTIONAL SERVICES.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XL13","ACCESSORIES AND SUPPLIES INCLUDED IN EQUIPMENT RENTAL REIMBURSEMENT","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","108","Rent/purchase guidelines were not met. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XL46","WHEN VALUE CODE 68 IS BILLED, EPOGEN/EPOETIN PROCEDURE CODE Q4081/Q4084 MUST BE PRESENT ON THE CLAIM.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XL66","THE PROVIDER TYPE AND CATEGORY OF SERVICE COMBINATION ARE NOT ALLOWED TO BILL FOR THIS SERVICE.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XL67","PROCEDURE CODES NOTED WITH CODE L ON THE PRACTITIONER FEE SCHEDULE CAN ONLY BE BILLED BY ENCOUNTER RATE CLINICS.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XL68","CLAIM MUST HAVE SAME FROM AND THROUGH MONTH.","M52","Missing/incomplete/invalid 'from' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XL74","VALUE CODE UNITS DOES NOT EQUAL THE SUM","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XL94","OBSTETRIC/GYNECOLOGY PROVIDERS ARE REIMBURSED FOR THE HPV VACCINE PRODUCT FOR THE CDCâ\u0080\u0099S ACIP RECOMMENDED AGES AS SHOWN IN THE STATE MAX COLUMN WHEN BILLED WITH SL MODIFIER.","N657","This should be billed with the appropriate code for these services.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM07","CLAIMS SUBMITTED WITH STUDENT TAXONOMY 390200000X DO NOT QUALIFY FOR REIMBURSEMENT.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XM19","COVID VACCINES BILLED BY FQHCS MUST BE BILLED ON A SEPARATE CLAIM.","N61","Rebill services on separate claims.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM20","Encounter Clinics must bill the encounter code T1015, T1040 or S5190 unless billing a LARC or vaccine supplied by VFC.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM21","INPATIENT CLAIMS AND LTC CLAIMS MUST BILL A VALUE CODE 80 FOR DAYS COVERED.","M49","Missing/incomplete/invalid value code(s) or amount(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM27","NOT SEPARATELY PAYABLE. INCLUDED IN DRG PAYMENT.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XM28","NOT SEPARATELY PAYABLE. INCLUDED IN CASE/PER-DIEM PAYMENT.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XM61","BILLING PROVIDER CANNOT BILL ESRD SERVICES ON A HCFA CLAIM TYPE. IT MUST BE BILLED ON A UB CLAIM TYPE.","N34","Incorrect claim form/format for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM63","BILLING TAXONOMY IS NOT APPROPRIATE FOR AMBULATORY SURGERY CENTER BILL TYPE.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM64","BILLING TAXONOMY IS NOT APPROPRIATE FOR SKILLED NURSING FACILITY BILL TYPE.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM65","BILLING TAXONOMY IS NOT APPROPRIATE FOR SKILLED NURSING INPATIENT BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM66","BILLING TAXONOMY IS NOT APPROPRIATE FOR INTERMEDIATE CARE NURSING FACILITY BILL TYPE.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM67","BILLING TAXONOMY IS NOT APPROPRIATE FOR INTERMEDIATE CARE NURSING FACILITY BILL TYPE 66X.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM68","BILLING TAXONOMY IS NOT APPROPRIATE FOR CLINIC BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM69","BILLING TAXONOMY IS NOT APPROPRIATE FOR INPATIENT BILL TYPE.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM70","BILLING TAXONOMY IS NOT APPROPRIATE FOR INPATIENT BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM71","BILLING TAXONOMY IS NOT APPROPRIATE FOR OUTPATIENT BILL TYPE.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM72","BILLING TAXONOMY IS NOT APPROPRIATE FOR OUTPATIENT BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM73","BILLING TAXONOMY IS NOT APPROPRIATE FOR HOSPICE BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM74","BILLING TAXONOMY IS NOT APPROPRIATE FOR CRITICAL ACCESS HOSPITAL BILL TYPE.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM75","BILLING TAXONOMY IS NOT APPROPRIATE FOR HOME HEALTH BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM76","BILLING TAXONOMY IS NOT APPROPRIATE FOR HOSPICE BILL TYPE 81X.","N255","Missing/incomplete/invalid billing provider taxonomy.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM77","BILLING TAXONOMY IS NOT APPROPRIATE FOR FREE STANDING BIRTHING CENTER BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM78","BILLING TAXONOMY IS NOT APPROPRIATE FOR INPATIENT BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM79","BILLING TAXONOMY IS NOT APPROPRIATE FOR FACILITY BILL TYPE.","N94","Claim/Service denied because a more specific taxonomy code is required for adjudication.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM80","PSYCHIATRIC HOSPITAL CAN NOT BILL OUTPATIENT ER CLAIMS WITH REVENUE CODES 450, 451, 452, 456, OR 459.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XM95","LEAVE OF ABSENCE REVENUE CODES ARE NOT PAYABLE.","N216","We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XM98","CMHCS, BHCS, INDEPENDENT PRACTITIONERS (PSYCHIATRISTS, LICENSED CLINICAL SOCIAL WORKERS AND LICENSED CLINICAL PSYCHOLOGISTS) CANNOT BILL PLACE OF SERVICE 02 OR WITH MODIFIER GT.","M77","Missing/incomplete/invalid/inappropriate place of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN00","FLUORIDE PROCEDURE (D1206) IS ONLY AVAILABLE FOR PAYMENT TWICE A YEAR FOR MEMBER AGES 3-20","M90","Not covered more than once in a 12 month period.","CO","Contractual Obligations","119","Benefit maximum for this time period or occurrence has been reached."]
["XN13","HCPCS CODE Q3014 TO BE BILLED IN CONJUNCTION WITH REVENUE CODE 0780.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN16","PROCEDURE CODE 97140 DESCRIBES A PHYSICAL THERAPY SERVICE SUBMITTED WITH AN INAPPROPRIATE PLACE OF SERVICE. MUST BE IN OFFICE OR HOME.","","","CO","Contractual Obligations","5","The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN35","CLAIM PAID AT ENCOUNTER RATE","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XN36","LONG ACTING CONTRACEPTIVE DEVICES (LARCS) ARE FEE-FOR-SERVICE WHEN BILLED SEPARATELY","N61","Rebill services on separate claims.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XN39","DME PROCEDURES BILLED WITH RR MODIFIER AND NO RENTAL PRICE IS NOTED, REIMBURSEMENT IS 10% OF PURCHASE PRICE","","","CO","Contractual Obligations","45","Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)"]
["XN40","IF A SUPR/DASA PROVIDER IS BILLING WITH TAXONOMY 324500000X OR 3245S0500X, AN ADMISSION CODE FROM 1-5 MUST BE BILLED. ADMISSION TYPE 9 IS NOT VALID FOR ILLINOIS MEDICAID.","MA41","Missing/incomplete/invalid admission type.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN41","Non Emergent claims are not payable to providers with category of service 051.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XN46","HOSPICE REV 0657 MUST HAVE A CORRESPONDING CPT/HCPC CODE BILLED","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN48","\"DENTAL FLOURIDE (D1206/D1208) IS ONLY APPLICABLE FOR AGES 3-20\"","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN53","Procedure code {CPT} is not valid for member age","","","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN54","CRNA and Anesthesiologist can no longer bill surgery procedures effective 10/01/2021.","","","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN55","CPT CODE IS NOT ALLOWED WITH BILLED OUTPATIENT PSYCH REVENUE CODE","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XN65","Long Acting Contraceptive Devices (LARCs) cannot bill more than 1 unit","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","151","Payment adjusted because the payer deems the information submitted does not support this many/frequency of services."]
["XN70","LONG ACTING REVERSIBLE CONTRACEPTION (LARC) MUST BE BILLED SEPARATELY FROM THE ENCOUNTER.","N61","Rebill services on separate claims.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XN95","LIMIT DDP CODES TO 1 PER YEAR","N362","The number of Days or Units of Service exceeds our acceptable maximum.","CO","Contractual Obligations","222","Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XN97","PER HFS, AN ASSISTANT SURGEON IS NOT ALLOWED FOR THIS PROCEDURE CODE","","","CO","Contractual Obligations","54","Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP01","Incorrect reporting of modifier PT","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP02","Non-covered service reported with inpatient only procedure where patient expired or transferred","N431","Not covered with this procedure.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP03","340B-acquired drug modifier(s) reported inappropriately","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP17","DIAGNOSIS R6813 AND Z761 ONLY PAY FOR AGES 0-2.","","","CO","Contractual Obligations","9","The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP18","G0379 IS NOT PAYABLE PER IAMHP GUIDELINES.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","256","Service not payable per managed care contract."]
["XP21","Due to anatomical limits, only one reimbursement is permitted for once-in-a-lifetime services {CPT}","N117","This service is paid only once in a patient's lifetime.","CO","Contractual Obligations","149","Lifetime benefit maximum has been reached for this service/benefit category."]
["XP31","ESRD Claims with REV 821, 831, or 881 must not be billed with revenue codes 0841 or 0851.","M50","Missing/incomplete/invalid revenue code(s).","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP35","A $10 per diem add-on should be applied to double occupancy rooms for Specialized Mental Health Rehabilitation Facilities that bill with revenue code 120.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP39","The provider type {0} and category of service {1} combination are not allowed to bill for this service.","N767","The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed.","CO","Contractual Obligations","185","The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP42","A $15 per diem add-on should be applied to single occupancy rooms for Specialized Mental Health Rehabilitation Facilities that bill\nwith revenue code 110.\"","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP48","Medicare only covers abortion service procedure codes when billed with the appropriate condition codes","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP49","Medicare will pay for abortion services only when billed with the \"\"G7\"\" modifier","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","97","The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP50","Home Infusion Therapy (HIT) Professional Services Category 1 G-codes should be billed with the appropriate J-code drug","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP51","Home Infusion Therapy (HIT) Professional Services Category 2 G-codes should be billed with the appropriate J-code drug and JB modifier","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP60","Monkeypox vaccines must be billed with SE modifier.","N519","Invalid combination of HCPCS modifiers.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP64","Deny Full term uncomplicated delivery with gestational age of less than 39 weeks","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP65","Deny Full term uncomplicated delivery with gestational age of less than 39 weeks","N569","Not covered when performed for the reported diagnosis.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP66","Deny No Gestational Age Indicator- Vaginal Delivery","M127","Missing patient medical record for this service.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP67","Deny No Gestational Age Indicator- C-Section","M127","Missing patient medical record for this service.","CO","Contractual Obligations","50","These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP68","Procedure J0248 is not allowed for patients under 28 days of life","N129","Not eligible due to the patient's age.","CO","Contractual Obligations","6","The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP72","Psych Clinic Type Part A and Part B may not be billed together.","N61","Rebill services on separate claims.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP75","Billed charges are less than or equal to $0.01.","MA22","Payment of less than $1.00 suppressed.","CO","Contractual Obligations","130","Claim submission fee."]
["XP80","This edit is triggered if the statement from or through dates are not billed in accordance with CMS guidelines.","M59","Missing/incomplete/invalid 'to' date(s) of service.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP82","T1040 behavioral health clinic services must be billed with mental health provider modifier AH, AJ, HO","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP83","T1015 should not be billed with mental health provider modifier AH, AJ, or HO.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XP86","If CPTs 90670, 90732, 90677, or 90671 are billed, then CPT code G0009 (administration of pneumococcal vaccine) must be present.","N572","This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.","CO","Contractual Obligations","182","Procedure modifier was invalid on the date of service."]
["XP87","Outpatient Providers billing psych services must be registered COS 27/28.","","","CO","Contractual Obligations","B7","This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XP96","H0006 is not payable to this provider.","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","8","The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["PPCF","PROVIDER MEDICAID ID ON PATIENT CREDIT FILE DOES NOT MATCH CLAIM","N95","This provider type/provider specialty may not bill this service.","CO","Contractual Obligations","208","National Provider Identifier - Not matched."]
["XQ20","PROCEDURE: THE PROCEDURE IS NOT TYPICAL FOR PATIENTS AGE.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ21","PROCEDURE: THE PROCEDURE IS NOT TYPICAL FOR PATIENTS GENDER.","MA39","Missing/incomplete/invalid gender.","CO","Contractual Obligations","7","The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ39","THE U4 MODIFIER MAY NOT BE USED WHEN BILLING GLOBAL OB CARE CODES","N517","Resubmit a new claim with the requested information.","CO","Contractual Obligations","4","The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ40","$25.50 per diem add-on  applied to single occupancy\nrooms for SMHR Facilities that bill with revenue code 110.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ41","14.50 per diem add-on should be applied to double occupancy rooms for Specialized Mental Health Rehabilitation Facilities that bill with revenue code 120.","N130","Consult plan benefit documents/guidelines for information about restrictions for this service.","CO","Contractual Obligations","96","Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ47","Effective June 1, 2024 hospitals must bill covid vaccine and administration codes on an 837I claim form.","N61","Rebill services on separate claims.","CO","Contractual Obligations","170","Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present."]
["XQ57","99070 must be billed on a separate claim from the T1015 or S5190.","N61","Rebill services on separate claims.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ58","99070 when billed by FQHC,ERC, or RHC must bill with appropriate HCPCS drug code.","M20","Missing/incomplete/invalid HCPCS.","CO","Contractual Obligations","16","Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["XQ70","HPV Vaccine 90651 is only allowed for patients age 46 and up when billed with diagnosis code N87.9","M76","Missing/incomplete/invalid diagnosis or condition.","CO","Contractual Obligations","11","The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."]
["ITRA","PROCEDURE MAY BE REBUNDLED TO A DIFFERENT CODE.","M15","Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.","CO","Contractual Obligations","234","This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"]
["90","NON-TIMELY FILED CLAIM, PATIENT NOT RESPONSIBLE.","","","CO","Contractual Obligations","29","The time limit for filing has expired."]
["29","THE TIME LIMIT FOR FILING HAS EXPIRED.","","","CO","Contractual Obligations","29","The time limit for filing has expired."]
["WVPD","Member Not Eligible for 1115 Waiver Program Benefit","","","CO","Contractual Obligations","177","Patient has not met the required eligibility requirements."]