Medicaid Claim Denial Codes
A0 Patient refund amount.A1 Claim denied charges.
A2 Contractual adjustment.
Note: Inactive for version 004060. Use Code 45 with Group Code 'CO' or use another
appropriate specific adjustment code.
A3 Medicare Secondary Payer liability met.
Note: Inactive for 004010, since 6/98.
A4 Medicare Claim PPS Capital Day Outlier Amount.
A5 Medicare Claim PPS Capital Cost Outlier Amount.
A6 Prior hospitalization or 30 day transfer requirement not met.
Note:
A7 Presumptive Payment Adjustment
Note:
A8 Claim denied; ungroupable DRG
B1 Non-covered visits.
Note:
B2 Covered visits.
Note: Inactive for 003040
B3 Covered charges.
Note: Inactive for 003040
B4 Late filing penalty.
B5 Payment adjusted because coverage/program guidelines were not met or were
exceeded.
Note: Changed as of 2/01
B6 This payment is adjusted when performed/billed by this type of provider, by this type
of provider in this type of facility, or by a provider of this specialty.
Note: Changed as of 2/01. This code will be deactivated on 2/1/2006.
B7 This provider was not certified/eligible to be paid for this procedure/service on this
date of service.
Note: Changed as of 10/98
B8 Claim/service not covered/reduced because alternative services were available, and should have been utilized.
B9 Services not covered because the patient is enrolled in a Hospice.
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.
Note:
B11 The claim/service has been transferred to the proper payer/processor for processing.
Claim/service not covered by this payer/processor.
Note:
B12 Services not documented in patients' medical records.
Note:
B13 Previously paid. Payment for this claim/service may have been provided in a previous
payment.
Note:
B14 Payment denied because only one visit or consultation per physician per day is
covered.
Note: Changed as of 2/01
B15 Payment adjusted because this procedure/service is not paid separately.
Note: Changed as of 2/01
B16 Payment adjusted because `New Patient' qualifications were not met.
Note: Changed as of 2/01
B17 Payment adjusted because this service was not prescribed by a physician, not
prescribed prior to delivery, the prescription is incomplete, or the prescription is not
current.
Note: Changed as of 2/01. This code will be deactivated on 2/1/2006.
B18 Payment adjusted because this procedure code and modifier were invalid on the date
of service
Note: Changed as of 2/01, 6/05
B19 Claim/service adjusted because of the finding of a Review Organization.
Note: Inactive for 003070
B20 Payment adjusted because procedure/service was partially or fully furnished by
another provider.
Note: Changed as of 2/01
B21 The charges were reduced because the service/care was partially furnished by another
physician.
Note: Inactive for 003040
B22 This payment is adjusted based on the diagnosis.
Note: Changed as of 2/01
B23 Payment denied because this provider has failed an aspect of a proficiency testing
program.
Note: Changed as of 2/01
D1 Claim/service denied. Level of subluxation is missing or inadequate.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D2 Claim lacks the name, strength, or dosage of the drug furnished.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D3 Claim/service denied because information to indicate if the patient owns the
equipment that requires the part or supply was missing.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D4 Claim/service does not indicate the period of time for which this will be needed.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D5 Claim/service denied. Claim lacks individual lab codes included in the test.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D6 Claim/service denied. Claim did not include patient's medical record for the service.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D7 Claim/service denied. Claim lacks date of patient's most recent physician visit.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D8 Claim/service denied. Claim lacks indicator that `x-ray is available for review.'
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
A0 Patient refund amount.A1 Claim denied charges.
A2 Contractual adjustment.
Note: Inactive for version 004060. Use Code 45 with Group Code 'CO' or use another
appropriate specific adjustment code.
A3 Medicare Secondary Payer liability met.
Note: Inactive for 004010, since 6/98.
A4 Medicare Claim PPS Capital Day Outlier Amount.
A5 Medicare Claim PPS Capital Cost Outlier Amount.
A6 Prior hospitalization or 30 day transfer requirement not met.
Note:
A7 Presumptive Payment Adjustment
Note:
A8 Claim denied; ungroupable DRG
B1 Non-covered visits.
Note:
B2 Covered visits.
Note: Inactive for 003040
B3 Covered charges.
Note: Inactive for 003040
B4 Late filing penalty.
B5 Payment adjusted because coverage/program guidelines were not met or were
exceeded.
Note: Changed as of 2/01
B6 This payment is adjusted when performed/billed by this type of provider, by this type
of provider in this type of facility, or by a provider of this specialty.
Note: Changed as of 2/01. This code will be deactivated on 2/1/2006.
B7 This provider was not certified/eligible to be paid for this procedure/service on this
date of service.
Note: Changed as of 10/98
B8 Claim/service not covered/reduced because alternative services were available, and should have been utilized.
B9 Services not covered because the patient is enrolled in a Hospice.
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.
Note:
B11 The claim/service has been transferred to the proper payer/processor for processing.
Claim/service not covered by this payer/processor.
Note:
B12 Services not documented in patients' medical records.
Note:
B13 Previously paid. Payment for this claim/service may have been provided in a previous
payment.
Note:
B14 Payment denied because only one visit or consultation per physician per day is
covered.
Note: Changed as of 2/01
B15 Payment adjusted because this procedure/service is not paid separately.
Note: Changed as of 2/01
B16 Payment adjusted because `New Patient' qualifications were not met.
Note: Changed as of 2/01
B17 Payment adjusted because this service was not prescribed by a physician, not
prescribed prior to delivery, the prescription is incomplete, or the prescription is not
current.
Note: Changed as of 2/01. This code will be deactivated on 2/1/2006.
B18 Payment adjusted because this procedure code and modifier were invalid on the date
of service
Note: Changed as of 2/01, 6/05
B19 Claim/service adjusted because of the finding of a Review Organization.
Note: Inactive for 003070
B20 Payment adjusted because procedure/service was partially or fully furnished by
another provider.
Note: Changed as of 2/01
B21 The charges were reduced because the service/care was partially furnished by another
physician.
Note: Inactive for 003040
B22 This payment is adjusted based on the diagnosis.
Note: Changed as of 2/01
B23 Payment denied because this provider has failed an aspect of a proficiency testing
program.
Note: Changed as of 2/01
D1 Claim/service denied. Level of subluxation is missing or inadequate.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D2 Claim lacks the name, strength, or dosage of the drug furnished.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D3 Claim/service denied because information to indicate if the patient owns the
equipment that requires the part or supply was missing.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D4 Claim/service does not indicate the period of time for which this will be needed.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D5 Claim/service denied. Claim lacks individual lab codes included in the test.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D6 Claim/service denied. Claim did not include patient's medical record for the service.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D7 Claim/service denied. Claim lacks date of patient's most recent physician visit.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D8 Claim/service denied. Claim lacks indicator that `x-ray is available for review.'
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
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