EOB Codes and Descriptions - Kymmis.com

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KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB583584585586587588HIPAAADJ RSNCODESMMIS EXCEPTIONMEDICAID DESCRIPTIONCODE(S)CLAIM/DETAIL DENIED. INDICATEDPREVENTION PROCEDURE CODES ARELIMITED TO A COMBINED TOTAL OF 108UNITS PER RECIPIENT, PER PREGNANCY. 583 119CLAIM/DETAIL DENIED. CERTAINOUTPATIENT SERVICES PROCEDURECODES ARE LIMITED TO A COMBINED TOTALOF 32 UNITS PER RECIPIENT, PERCALENDAR WEEK (SUNDAY THRUSATURDAY). 584 119CLAIM/DETAIL DENIED. INTENSIVEOUTPATIENT NON-RESIDENTIAL SERVICESPROCEDURE CODES ARE LIMITED TO ACOMBINED TOTAL OF 28 UNITS PERRECIPIENT, PER DAY. 585 119CLAIM/DETAIL DENIED. INTENSIVEOUTPATIENT NON-RESIDENTIAL SERVICESPROCEDURE CODES ARE LIMITED TO ACOMBINED TOTAL OF 80 UNITS PERRECIPIENT, PER CALENDAR WEEK (SUNDAYTHRU SATURDAY). 586 119CLAIM/DETAIL DENIED. DAY REHABILITATIONPROCEDURE CODES ARE LIMITED TO ACOMBINED TOTAL OF 8 UNITS PERRECIPIENT, PER DAY. 587 119CLAIM/DETAIL DENIED. DAY REHABILITATIONPROCEDURE CODES ARE LIMITED TO ACOMBINED TOTAL OF 45 UNITS PERRECIPIENT, PER CALENDAR WEEK (SUNDAYTHRU SATURDAY). 588 119HIPAA ADJ RSN CODEDESCRIPTIONBenefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.HIPAAREMARKM139M139M139M139M139M139HIPAA REMARK CODEDESCRIPTIONDenied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.589590591592CLAIM/DETAIL DENIED. PROCEDURE CODEWB233 NOT PAYABLE UNLESS BILLED INCONJUNCTION WITH WB232 (DATES OFSERVICE WITHIN 30 DAYS OF EACH OTHER). 589 107HOSPITAL OUTPATIENT SERVICES NON-PAYABLE DURING A HOSPITAL INPATIENTSTAY. 590 60CLAIM/DETAIL DENIED. OUTPATIENTTHERAPIES INDIVIDUAL, GROUP, ANDFAMILY PROCEDURE CODES ARE NOTPAYABLE ON THE SAME DATE OF SERVICEAS INTENSIVE OUTPATIENT SERVICES NON-RESIDENTIAL AND DAY REHABILITATIONPROCEDURES. 591 97CLAIM/DETAIL DENIED. INTENSIVEOUTPATIENT SERVICES NON-RESIDENTIALAND DAY REHABILITATION PROCEDURECODES ARE NOT PAYABLE ON THE SAMEDATE OF SERVICE AS OUTPATIENTTHERAPIES INDIVIDUAL, GROUP, & FAMILYPROCEDURES. 592 97Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.Charges for outpatient serviceswith this proximity to inpatientservices are not covered.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.N56N20M86N20M86Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.593CLAIM DENIED. THIS PROCEDURE IS NOTPAYABLE UNLESS BILLED IN CONJUNCTIONWITH WB505, WB507, WB508, WB509,WB516, WB521, WB522, WB523, WB526,WB602, WB603 OR WB604 (DATES OFSERVICE WITHIN 30 DAYS OF EACH OTHER). 593 107Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.N56Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.594596597CLAIM DENIED. CLAIM EXCEEDS 140 DAYACID/PEPTIC THERAPY LIMITATION. 594 119CLAIM DETAIL DENIED. OFFICE VISITS NOTALLOWED WITHIN 10 DAYS FOLLOWING ASURGICAL PROCEDURE. 596 97CLAIM/DETAIL DENIED. THIS PROCEDURE ISNOT PAYABLE AFTER THE DATE OFDELIVERY. 597 97Benefit maximum for this timeperiod has been reached.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.M139N19M67Denied services exceed the coveragelimit for the demonstration.Procedure code incidental to primaryprocedure.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).598CLAIM DETAIL DENIED. ONLY ONE 'E AND M'CODE ALLOWED PER DATE OF SERVICE. 598 119599 CLAIM PENDING REVIEW OF HISTORY. 599 133Benefit maximum for this timeperiod has been reached.The disposition of thisclaim/service is pending furtherreview.M63We do not pay for more than one ofthese on the same day.Page 30 of 46 Date: 3/30/2005
KYEOBMEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODES600 EYE EXAM LIMITED TO OPTOMETRIST. 600 B58HIPAA ADJ RSN CODEDESCRIPTIONPayment adjusted becausecoverage/ program guidelineswere not met or were exceeded.The procedure code isinconsistent with the providertype/specialty (taxonomy).HIPAAREMARKHIPAA REMARK CODEDESCRIPTION601602ONLY 3 FOLLOW UP EXAMS ARE ALLOWEDPER 6 MONTHS. 601 119CLAIM DENIED. LIMIT 2 ROUTINEORTHODONTICS PER RECIPIENT PER 12MONTHS 602 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.603604CLAIM DENIED. EACH RECIPIENT ALLOWEDONE FULL MOUTH RADIOGRAPHY EVERY 2YEARS PER PROVIDER. 603 119Benefit maximum for this timeperiod has been reached.M139MORE THAN 2 OF THE COMPONENT TESTSOF A CBC PERFORMED ON THE SAME DOSMUST BE BILLED AS A CBC. 604 A1 Claim denied charges. N19Denied services exceed the coveragelimit for the demonstration.Procedure code incidental to primaryprocedure.605ONLY FOUR PSYCHIATRIC PROCEDURESALLOWED PER YEAR, PER PROVIDER, PERRECIPIENT. 605 119Benefit maximum for this timeperiod has been reached.M15M139Separately billed services/tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowedDenied services exceed the coveragelimit for the demonstration.606607608609610PROCEDURE CODE 02951 CAN ONLY BEBILLED ALONE OR WITH MONITOREDPROCEDURE CODES FOR THE SAMERECIPIENT, SAME PROVIDER, SAME DATEOF SERVICE, AND SAME TOOTH NUMBER. 606 107EACH RECIPIENT ALLOWED 4 SINGLEBITEWING X-RAYS PER 12 MONTHS PERPROVIDER. 607 119CLAIM DENIED. THIS SERVICE IS LIMITED TOONE PER RECIPIENT, PER PROVIDER, PERCALENDAR MONTH. 639, 651 119CLAIM DENIED. ONE DENTALPROPHYLAXIS/FLUORIDE TREATMENT PERRECIPIENT PER 12 MONTH PERIOD. 609 119CLAIM DENIED. EACH RECIPIENT ALLOWEDONE UPPER TRANSITIONAL APPLIANCE PER12 MONTHS. 610 119Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.N56M139M139M90M90Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Not covered more than once in a 12month period.Not covered more than once in a 12month period.611612613614615616617RECIPIENT ALLOWED THREE TRANSITIONALAPPLIANCE REPAIRS PER 12 MONTHS. 611 119ONLY 9 UNITS (ADULT DAY HABILITATION)ALLOWED PER DATE OF SERVICE PERRECIPIENT. 612 119RESIDENTIAL RESPITE DAILY SERVICEALLOWED FOR ONLY 30 CONSECUTIVEDAYS. 613 119RECIPIENT ALLOWED ONLY 30CONSECUTIVE DAY OF IN-HOME RESPITEDAILY SERVICE. 614 119MAXIMUM OF 40 DAYS RESIDENTIALRESPITE COMBINING DAILY AND HOURLYSERVICES PER RECIPIENT PER CALENDARYEAR. 615 119MAXIMUM OF 60 DAYS IN-HOME RESPITEALLOWED COMBINING DAILY AND HOURLYSERVICES PER RECIPIENT PER CALENDARYEAR. 616 119RECIPIENT ALLOWED 1 INITIAL OFFICE VISITWITH COMPLETE DIAGNOSIS PER 9MONTHS. 617 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139M139M139M139M139M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.618ONLY ONE DELIVERY ALLOWED PERRECIPIENT/9 MOS. 618 119Benefit maximum for this timeperiod has been reached.M139Denied services exceed the coveragelimit for the demonstration.619620RECIPIENT ALLOWED POST-PARTUM CARE2 TIMES PER YEAR. 619 119MAXIMUM DAILY DOSE EXCEEDED - PRIORAUTHORIZATION REQUIRED. 620, 632 11962Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.M139Denied services exceed the coveragelimit for the demonstration.Page 31 of 46 Date: 3/30/2005
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Page 5 and 6: KYEOB079080081082083084KENTUCKY EOB
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Page 15 and 16: KYEOB273KENTUCKY EOB/ESC CROSSWALK
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