Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesM70M71M73M74M75M76M77M79DescriptionAlert: The NDC code submitted for this service was translated to aHCPCS code for processing, but please continue to submit the NDC onfuture claims for this item.Start: 01/01/1997 | Last Modified: 08/01/2007Notes: (Modified 4/1/2007, 8/1/07)Total payment reduced due to overlap of tests billed.Start: 01/01/1997The HPSA/Physician Scarcity bonus can only be paid on theprofessional component of this service. Rebill as separate professionaland technical components.Start: 01/01/1997 | Last Modified: 08/01/2004Notes: (Modified 8/1/04)This service does not qualify for a HPSA/Physician Scarcity bonuspayment.Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04)Multiple automated multichannel tests performed on the same daycombined for payment.Start: 01/01/1997 | Last Modified: 11/05/2007Notes: (Modified 11/5/07)Missing/incomplete/invalid diagnosis or condition.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)Missing/incomplete/invalid place of service.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)Missing/incomplete/invalid charge.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)10
ReasonDescriptionCodesM80 Not covered when performed during the same session/date as apreviously processed service for the patient.Start: 01/01/1997 | Last Modified: 10/31/2002Notes: (Modified 10/31/02)M81 You are required to code to the highest level of specificity.Start: 01/01/1997 | Last Modified: 02/01/2004Notes: (Modified 2/1/04)M82 Service is not covered when patient is under age 50.Start: 01/01/1997M83 Service is not covered unless the patient is classified as at high risk.Start: 01/01/1997M84 Medical code sets used must be the codes in effect at the time ofserviceStart: 01/01/1997 | Last Modified: 02/01/2004Notes: (Modified 2/1/04)M85 Subjected to review of physician evaluation and management services.Start: 01/01/1997M86 Service denied because payment already made for same/similarprocedure within set time frame.Start: 01/01/1997 | Last Modified: 06/30/2003Notes: (Modified 6/30/03)M87 Claim/service(s) subjected to CFO-CAP prepayment review.Start: 01/01/1997M89 Not covered more than once under age 40.Start: 01/01/1997M90 Not covered more than once in a 12 month period.Start: 01/01/199711
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ReasonCodesN230N231N232N233N234N235
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ReasonCodesN355DescriptionAlert: Th
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Claim Adjustment Reason Codes - Palmetto GBA

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