Claim Adjustment Reason Codes - Palmetto GBA

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ReasonDescriptionCodesM29 Missing operative note/report.Start: 01/01/1997 | Last Modified: 07/01/2008Notes: (Modified 2/28/03, 7/1/2008) Related to N233M30 Missing pathology report.Start: 01/01/1997 | Last Modified: 08/01/2004Notes: (Modified 8/1/04, 2/28/03) Related to N236M31 Missing radiology report.Start: 01/01/1997 | Last Modified: 08/01/2004Notes: (Modified 8/1/04, 2/28/03) Related to N240M32 Alert: This is a conditional payment made pending a decision on thisservice by the patient's primary payer. This payment may be subject torefund upon your receipt of any additional payment for this service fromanother payer. You must contact this office immediately upon receipt ofan additional payment for this service.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Modified 4/1/07)M36 This is the 11th rental month. We cannot pay for this until you indicatethat the patient has been given the option of changing the rental to apurchase.Start: 01/01/1997M37 Service not covered when the patient is under age 35.Start: 01/01/1997M38 The patient is liable for the charges for this service as you informed thepatient in writing before the service was furnished that we would notpay for it, and the patient agreed to pay.Start: 01/01/19976
ReasonCodesM39M40M41M42M44M45M46M47M49DescriptionThe patient is not liable for payment for this service as the advancenotice of non-coverage you provided the patient did not comply withprogram requirements.Start: 01/01/1997 | Last Modified: 11/01/2009Notes: (Modified 2/1/04, 4/1/07, 11/1/09)Claim must be assigned and must be filed by the practitioner'semployer.Start: 01/01/1997We do not pay for this as the patient has no legal obligation to pay forthis.Start: 01/01/1997The medical necessity form must be personally signed by the attendingphysician.Start: 01/01/1997Missing/incomplete/invalid condition code.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)Missing/incomplete/invalid occurrence code(s).Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04) Related to N299Missing/incomplete/invalid occurrence span code(s).Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04) Related to N300Missing/incomplete/invalid internal or document control number.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)Missing/incomplete/invalid value code(s) or amount(s).Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)7
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Page 32 and 33: ReasonCodesMA125MA126MA128MA130MA13
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ReasonCodesN188N189N190N191N192N193
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ReasonCodesN355DescriptionAlert: Th
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Claim Adjustment Reason Codes - Palmetto GBA

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