Remark code - N357, M119, M123, M2, M50, M54 & N129, N130, N19

Denial Code 45, 50, 54,58, 59, 60, 96, 97 and related remark codes

Adj. Reason Code	Adj. Reason Code Description	Remark Code	Remark Code Description	Exception Code Description
45	Charges exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability).			SUBMITTED CHARGE ON 340B CLAIM TOO HIGH
50	These are non-covered services because this is not deemed a `medical necessity' by the payer.			RECIPIENT DENIED NO MEDICAL NEED
54	Multiple physicians/assistants are not covered in this case.			ASSISTANT SURGEON NOT COVERED
58	Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.			RECIP DENIED INAPP PLCMNT
59	Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia).			TWO ANESTHESIA SERVICES
60	Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.	N357	Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.	INPT/OUTPT CONFLCT
				PAID OUTPT CLAIM CONFLICT
60	Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.			OUTPT/DRG CONFLICT
				EMERGENCY ROOM NOT PAYABLE
				EMERG ROOM OTH/SVCS NOT PAYBLE
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).	M119	Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (NDC).	DRUG DISCONTD- NO ALTERNATE
				DRUG DISCONTD-BILL REPLACEMENT
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).	M123	Missing/incomplete/invalid name, strength, or dosage of the drug furnished.	COMPOUND NOT COVERED FOR PROGRAM TYPE
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).	M2	Not paid separately when the patient is an inpatient.	INPT OT IS PART OF HOSP PYMT
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).	M50	Missing/incomplete/invalid revenue code(s).	NON-COVERED MCAID REVENUE CODE
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).	M54	Missing/incomplete/invalid total charges.	INVALID TOTAL NON/COV CHARGE
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).	M67	Missing/incomplete/invalid other procedure code(s).	OTHER SURG PROC NOT COVERED
				OTHER PROC NOT COVERED (81)
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).	M79	Missing/incomplete/invalid charge.	XOVR CLM - CHIROPRACTOR NOT CVRD
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).	MA66	Missing/incomplete/invalid principal procedure code.	PRINCIPAL SURG PROC NOT CVRD
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).	N129	Not eligible due to the patient's age.	CHEC RECIPIENT AGE IS GREATER THAN 20
				INVAL RECIP AGE/DRUG(REF FILE)
				PROC NOT PAYABLE FOR AGE OR PROV TYPE
				TOOTH NOT COVERED FOR ROOT CANAL
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).	N130	Consult plan benefit documents/guidelines for information about restrictions for this service.	INPT PSYC,REHAB/SURG CNFLCT
				X-OVER NOT COVERED FOR PCN
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).	N216	We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.	NONCOVERED MEDICAID BENFIT
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).	N30	Patient ineligible for this service.	CUSTODY MEDICAL CARE CLAIMS
				CLAIM/REF FILE AID TYPE CONF
				EMERGENCY ONLY CLIENT NON COVERED SVC
				NURSING HOME CLAIM PCN ELIGIBLE
				INVALID PREGNANCY INDICATOR FOR DRUG
				NDC'S IN COMPOUND NON-COVERED
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.	M14	No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.	INJECTION/OFFICE CALL CONFLICT
				THERAPEUTIC INJECTION/OFFICE CALL CONFLICT
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.	M86	Service denied because payment already made for same/similar procedure within set time frame.	GLOBAL/OTHER DELVRY CONFLICT
				GLOBAL ALREADY PAID
				TWO GLOBAL - SAME CYCLE
				GLOBAL CARE PAID
				SRVC INCLUDED IN GLOBAL
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.	PAYMENT INCLUDED IN PRIMARY PROCEDURE
				CURRENT PROC INCIDNTL OTHER CURRENT PROC
				HIST PROC INCIDNTL OTHER CURRENT PROC
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.	N20	Service not payable with other service rendered on the same date.	UN-BUNDLED SERVICE VS BUNDLED SERVICE
				E&M SERVICE NOT REIMBURSED SEPARATELY
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.	N390	This service/report cannot be billed separately.	INJECTION PART OF ASPIRATION
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.			ASPIRATION/INJCTN CONFLICT
				SERVICE IS COVERED IN DHS DAILY RATE
				BUNDLED PROCEDURE/HISTORY OF PAID CLAIM
				EMER EXAM/OTHER SERV SAME DOS
				PD OUTPT CLAIM CONFLICT
				COG SERV IS IN PACKAGE PROC
				PROC COMBINATION NOT EXPECTED SAME DAY
				PROC COMBO NOT EXPTD SAME DAY,PD CLM HIS
				PAYMENT INC W/ DENTAL PACKAGE PROCEDURE
				PAYMENT INC W/DENTL PKG PROC,PD CLM HIST
				DENTL EXAM INC W PAYMENT OF ANOTHER CODE
				DENTL EXAM IN W PAYMENT OF PD CLM HIST
				DENTL PROC COMBO NOT EXPECTED SAME DAY
				D PROC COMBO NOT EXP SAME DAY,PD CLM HIS
				CURRNT PROC MUTUAL EXCLUSV TO HISTR PROC
				HIST PROC MUTUAL EXLUSV TO CURRENT PROC

N19 - Procedure code incidental to primary procedure.

Reason for denial:

Payer does not pay separately for this service

Some services/procedures are considered "always bundled". These services can never be separately
reimbursed.

To confirm whether the procedure billed is considered always bundled please refer to the carrier website or NCC Edits and check to see if the procedure has a status code of "B" or "P". If so it is always considered bundled and no additional reimbursement is paid by Medicare. Based on that we can call the carrier and argue to get paid.

Actions:

Confirm that you have billed the correct procedure code.
If the wrong code was originally submitted send a new claim.
If the correct code was used, write off the charges. Do not rebill the claim or bill the beneficiary.