Appeal Denial Crosswalk
Updated: 03.20.18
REMITTANCE ADJUSTMENT REASON CODE (RARC) DISPLAYED ON THE REMITTANCE ADVICE (RA) |
DESCRIPTION |
CLAIM ADJUSTMENT REASON CODE (CARC) DISPLAYED ON REMITTANCE ADVICE (RA) |
GENERIC DENIAL CODE |
GENERIC REASON STATEMENT |
---|---|---|---|---|
N522 |
THIS IS A DUPLICATE CLAIM BILLED BY THE SAME PROVIDER |
18 |
GBA01 |
THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY THE SAME PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3 |
N522 |
THIS IS A DUPLICATE CLAIM BILLED BY DIFFERENT PROVIDER |
18 |
GBA02 |
THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY A DIFFERENT PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3 |
N706 |
NO RECORDS WERE SUBMITTED |
250 |
GBB01 |
THE REQUESTED RECORDS WERE NOT RECEIVED. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8 |
N705 |
INCOMPLETE/ INSUFFICIENT DOCUMENTATION |
251 |
GBB02 |
THE DOCUMENTATION SUBMITTED WAS INCOMPLETE AND/OR INSUFFICIENT. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8, B/C |
N163 |
THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE |
150 |
GBB03 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT SERVICES WERE RENDERED AS BILLED. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A |
N455 |
DOES NOT CONTAIN PROVIDER ORDER |
251 |
GBB04 |
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A PHYSICIAN ORDER. REFER TO IOM, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2 |
N382 |
MISSING PATIENT IDENTIFIERS |
16 |
GBB05 |
THE DOCUMENTATION SUBMITTED WAS MISSING PATIENT IDENTIFIERS. REFER TO STANDARDS FOR ADEQUACY OF MEDICAL RECORDS; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT |
M53 |
INCORRECT DATE OF SERVICE |
110 |
GBB06 |
THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT DATE OF SERVICE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2 |
N519 |
INCORRECT MODIFIER |
4 |
GBB07 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MODIFIERS BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, IOM PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 |
N563 |
ABN DENIAL |
116 |
GBB08 |
THE ABN IS INVALID, INCOMPLETE OR MISSING. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 40.3.6 |
MA36 |
THE BENEFICIARY NAME ON THE DOCUMENTATION DOES NOT MATCH WHAT IS ON THE CLAIM |
16 |
GBB09 |
THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT BENEFICIARY. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8 |
N205 |
ILLEGIBLE DOCUMENTATION |
50 |
GBB10 |
THE DOCUMENTATION SUBMITTED IS NOT LEGIBLE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3 SECTION 3.3.2.1 |
M53 |
THE DOCUMENTATION DOES NOT SUPPORT THE NUMBER OF UNITS BILLED |
222 |
GBB11 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE NUMBER OF UNITS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23 |
N661 |
DOES NOT MEET MEDICAL NECESSITY |
50 |
GBC01 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY AS LISTED IN COVERAGE REQUIREMENT. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2 |
N661 |
DOES NOT MEET MEDICAL |
50 |
GBC02 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.1, 3.6.2.2 |
N643 |
NON COVERED SERVICE |
96 |
GBC03 |
THE SERVICE BILLED IS NOT A COVERED MEDICARE BENEFIT OR IS AN EXCLUDED SERVICE. REFER TO 42 CFR 411.15. MEDICARE BENEFIT POLICY MANUAL CHAPTER 16; CFR TITLE 42, CHAPTER IV, SUBCHAPTER B, PART 411 |
N435 |
DOES NOT SUPPORT NUMBER OF SERVICES FOR TIMEFRAME |
151 |
GBC04 |
THE DOCUMENTATION PROVIDED DOES NOT SUPPORT THE MEDICAL NECESSITY FOR THIS NUMBER OF SERVICES OR ITEMS WITHIN THIS TIMEFRAME. REFER TO SSA 1862, IOM, 100-08, MPIM CHAPTER 3, SECTION 3.6.2.2 |
N362 |
THE MAX BENEFIT AS BEEN REACHED FOR THIS SERVICE |
114 |
GBC05 |
THE MAXIMUM BENEFIT HAS BEEN REACHED FOR THIS SERVICE. REFER TO IOM, PUB 100-02, MEDICARE BENEFIT POLICY MANUAL CHAPTER 5 AND IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5 A |
N429 |
SERVICE WAS PERFORMED FOR ROUTINE/SCREENING BUT IS NOT A COVERED MEDICARE SCREENING BENEFIT |
96 |
GBC06 |
THE DOCUMENTATION INDICATES THAT THE SERVICE WAS PERFORMED FOR ROUTINE/SCREENING PURPOSES BUT IS NOT COVERED UNDER MEDICARE’S SCREENING BENEFIT. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 18 |
N705 |
BILLING ERROR |
16 |
GBD01 |
BILLING ERROR. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4; 100-04 MEDICARE CLAIMS PROCESSING MANUAL, CHAPTER 23. |
M15 |
BUNDLED OR INCLUDED IN ANOTHER CODE BILLED |
97 |
GBD03 |
BUNDLED OR INCLUDED IN ANOTHER CODE BILLED (NCCI). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 20.3; NATIONAL CORRECT CODING INITIATIVE CODING POLICY MANUAL FOR MEDICARE SERVICES; MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1 |
N163 |
DOES NOT SUPPORT SERVICE BILLED |
50 |
GBD04 |
THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE WAS PERFORMED AS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23 |
M64 |
DOES NOT SUPPORT DIAGNOSIS |
11 |
GBD05 |
THE DOCUMENTATION DOES NOT SUPPORT THE DIAGNOSIS CODE BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1 |
N525 |
GLOBAL SURGERY PERIOD |
97 |
GBD06 |
PAYMENT FOR THIS SERVICE IS COMPENSATED IN THE GLOBAL SURGICAL PERIOD. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12 SECTION 30.6.6 |
M15 |
BUNDLED IN ANOTHER SERVICE ON THE SAME DOS
|
97 |
GBD07 |
PAYMENT IS INCLUDED IN ANOTHER SERVICE RECEIVED ON THE SAME DATE (BUNDLED). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30 & 40 |
MA50 |
INVESTIGATIONAL |
55 |
GBD08 |
THIS SERVICE OR PROCEDURE IS CONSIDERED INVESTIGATIONAL AND, THEREFORE, NOT COVERED BY MEDICARE. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2 |
N163 |
DOES NOT SUPPORT ORDERED SERVICE |
50 |
GBD09 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE ORDERED SERVICE. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A |
N519 |
DOES NOT SUPPORT CPT MODIFIER 25 |
236 |
GBD10 |
THE DOCUMENTATION DOES NOT SUPPORT THAT A SEPARATELY IDENTIFIABLE SERVICE WAS PERFORMED. REFER TO IOM MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30.6; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT |
N19 |
APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID |
96 |
GBD11 |
THE APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.4 |
N383 |
COSMETIC PURPOSES |
96 |
GBD12 |
THE DOCUMENTATION SUBMITTED INDICATES THE SERVICE WAS PERFORMED FOR COSMETIC PURPOSES. REFER TO MEDICARE BENEFIT POLICY MANUAL CHAPTER 16, SECTION 120 |
N163 |
CLONED DOCUMENTATION |
50 |
GBD13 |
THE DOCUMENTATION SUBMITTED CONTAINS CLONED OR ALTERED INFORMATION. REFER TO PUB 100-8, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.3.2.5; CHAPTER 4.3 |
N705 |
BILLING ERROR |
250 |
GBD14 |
THE PROVIDER INDICATED SERVICES WERE BILLED IN ERROR. REFER TO SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT |
N206 |
DOCUMENT CONTAINS CONFLICTING INFORMATION |
50 |
GBD15 |
THE DOCUMENTATION CONTAINS CONFLICTING INFORMATION. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.3 |
M102 |
NOT FDA APPROVED |
55 |
GBD16 |
THE SERVICE OR DEVICE WAS NOT FDA APPROVED. REFER TO SSA 1862; MEDICARE BENEFIT POLICY MANUAL CHAPTER 14 |
N425 |
STATUTORILY EXCLUDED |
96 |
GBD17 |
THE SERVICE BILLED IS STATUTORILY EXCLUDED. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 20.1.1, SOCIAL SECURITY ACT 1862 (A), 12 CFR 411.15, MEDICARE BENEFIT POLICY MANUAL CHAPTER 16 |
N55 |
PERFORMING PROVIDER IS NOT BILLING PROVIDER |
B20/16 |
GBD18 |
THE DOCUMENTATION SUBMITTED SUPPORTS THE PERFORMING AND BILLING PROVIDERS ARE DIFFERENT |
M25 |
DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED |
150 |
GBE01 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MEDICAL NECESSITY OF THE LEVEL OF SERVICE BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23 |
M25 |
DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED |
150 |
GBE02 |
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.4 |
MA81 |
INVALID SIGNATURE OR CREDENTIALS |
50 |
GBF01 |
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND/OR CREDENTIALS. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24 |
MA81 |
NO RESPONSE TO ATTESTATION OR SIGNATURE LOG |
16 |
GBF02 |
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND A RESPONSE TO ATTESTATION OR SIGNATURE LOG REQUEST WAS NOT RECEIVED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24 |
MA81 |
STAMPED SIGNATURE |
50 |
GBF03 |
STAMPED SIGNATURES ARE NOT ACCEPTED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 |
N170 |
DID NOT INCLUDE REQUIRED CERTIFICATIONS |
50 |
GBG01 |
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE THE REQUIRED CERTIFICATIONS OR RECERTIFICATIONS. REFER TO MEDICARE BENEFIT POLICY MANUAL, CHAPTER 15, 220.1.3 |
MA81 |
NOT A VALID NPI |
207 |
GBH01 |
THE CLAIM DID NOT INCLUDE A VALID NPI. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1, SECTION 80.3.1 |
N705 |
DID NOT CONTAIN REQUIRED INFORMATION |
50 |
GBH02 |
THE CLAIM SUBMITTED DID NOT CONTAIN REQUIRED INFORMATION |