Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesN435N436N437N438N439N440N441N442N443N444N445N446DescriptionExceeds number/frequency approved /allowed within time periodwithout support documentation.Start: 07/01/2008The injury claim has not been accepted and a mandatory medicalreimbursement has been made.Start: 07/01/2008Alert: If the injury claim is accepted, these charges will be reconsidered.Start: 07/01/2008This jurisdiction only accepts paper claimsStart: 07/01/2008Missing anesthesia physical status report/indicators.Start: 07/01/2008Incomplete/invalid anesthesia physical status report/indicators.Start: 07/01/2008This missed appointment is not covered.Start: 07/01/2008Payment based on an alternate fee schedule.Start: 07/01/2008Missing/incomplete/invalid total time or begin/end time.Start: 07/01/2008Alert: This facility has not filed the Election for High Cost Outlier formwith the Division of Workers' Compensation.Start: 07/01/2008Missing document for actual cost or paid amount.Start: 07/01/2008Incomplete/invalid document for actual cost or paid amount.Start: 07/01/200878
ReasonCodesN447N448N449N450N451N452N453N454N455N456N457N458N459DescriptionPayment is based on a generic equivalent as required documentationwas not provided.Start: 07/01/2008This drug/service/supply is not included in the fee schedule orcontracted/legislated fee arrangementStart: 07/01/2008Payment based on a comparable drug/service/supply.Start: 07/01/2008Covered only when performed by the primary treating physician or thedesignee.Start: 07/01/2008Missing Admission Summary Report.Start: 07/01/2008Incomplete/invalid Admission Summary Report.Start: 07/01/2008Missing Consultation Report.Start: 07/01/2008Incomplete/invalid Consultation Report.Start: 07/01/2008Missing Physician Order.Start: 07/01/2008Incomplete/invalid Physician Order.Start: 07/01/2008Missing Diagnostic Report.Start: 07/01/2008Incomplete/invalid Diagnostic Report.Start: 07/01/2008Missing Discharge Summary.Start: 07/01/200879
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Medicare Specific Remark CodesLast
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ReasonCodesM20M21M22M23M24M25Descri
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ReasonDescriptionCodesM29 Missing o
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ReasonCodesM50M51M52M53M54M55M56M59
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ReasonCodesM112M113M114M115M116M117
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ReasonCodesM127M129M130M131M132M133
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ReasonCodesMA01MA02MA04MA07MA08MA09
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Page 28 and 29: ReasonCodesMA84MA88MA89MA90MA91MA92
Page 30 and 31: ReasonDescriptionCodesMA108 Paper c
Page 32 and 33: ReasonCodesMA125MA126MA128MA130MA13
Page 34 and 35: ReasonCodesN10N11N12N13N15N16N19N20
Page 44 and 45: ReasonCodesN103N104N105N106N107Desc
Page 46 and 47: ReasonCodesN115N116N117N118N119Desc
Page 48 and 49: ReasonCodesN125DescriptionPayment h
Page 50 and 51: ReasonCodesN137N138N139DescriptionA
Page 52 and 53: ReasonCodesN148N149N150N151N152N153
Page 70 and 71: ReasonCodesN355DescriptionAlert: Th
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Claim Adjustment Reason Codes - Palmetto GBA

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