Claim Adjustment Reason Codes - Palmetto GBA

ReasonCodesM102M103M104M105M107M109M111DescriptionService not performed on equipment approved by the FDA for thispurpose.Start: 01/01/1997Information supplied supports a break in therapy. However, the medicalinformation we have for this patient does not support the need for thisitem as billed. We have approved payment for this item at a reducedlevel, and a new capped rental period will begin with the delivery of thisequipment.Start: 01/01/1997Information supplied supports a break in therapy. A new capped rentalperiod will begin with delivery of the equipment. This is the maximumapproved under the fee schedule for this item or service.Start: 01/01/1997Information supplied does not support a break in therapy. The medicalinformation we have for this patient does not support the need for thisitem as billed. We have approved payment for this item at a reducedlevel, and a new capped rental period will not begin.Start: 01/01/1997Payment reduced as 90-day rolling average hematocrit for ESRD patientexceeded 36.5%.Start: 01/01/1997We have provided you with a bundled payment for a teleconsultation.You must send 25 percent of the teleconsultation payment to thereferring practitioner.Start: 01/01/1997We do not pay for chiropractic manipulative treatment when the patientrefuses to have an x-ray taken.Start: 01/01/199713