| M1 | X-ray not taken within the past 12 months or near enough to the start of treatment. Start: 1/1/1997 |
| M2 | Not paid separately when the patient is an inpatient. Start: 1/1/1997 |
| M3 | Equipment is the same or similar to equipment already being used. Start: 1/1/1997 |
| M4 | Alert: This is the last monthly installment payment for this durable medical equipment. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| M5 | Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed. Start: 1/1/1997 |
| M6 | Alert: You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for every 6 month period after the end of the 15th paid rental month or the end of the warranty period. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| M7 | No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price. Start: 1/1/1997 |
| M8 | We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen. Start: 1/1/1997 |
| M9 | Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| M10 | Equipment purchases are limited to the first or the tenth month of medical necessity. Start: 1/1/1997 |
| M11 | DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code. Start: 1/1/1997 |
| M12 | Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim. Start: 1/1/1997 |
| M13 | Only one initial visit is covered per specialty per medical group. Start: 1/1/1997 | Last Modified: 6/30/2007 Note: (Modified 6/30/03) |
| M14 | No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection. Start: 1/1/1997 |
| M15 | Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed. Start: 1/1/1997 |
| M16 | Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07) |
| M17 | Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| M18 | Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| M19 | Missing oxygen certification/re-certification. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N234 |
| M20 | Missing/incomplete/invalid HCPCS. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M21 | Missing/incomplete/invalid place of residence for this service/item provided in a home. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M22 | Missing/incomplete/invalid number of miles traveled. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M23 | Missing invoice. Start: 1/1/1997 | Last Modified: 8/1/2005 Note: (Modified 8/1/05) |
| M24 | Missing/incomplete/invalid number of doses per vial. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M25 | The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request a appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment. Start: 1/1/1997 | Last Modified: 11/5/2007 Note: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07) |
| M26 | The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service /any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice. The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office. Start: 1/1/1997 | Last Modified: 11/5/2007 Note: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356) |
| M27 | Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office. Start: 1/1/1997 | Last Modified: 8/1/2007 Note: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07) |
| M28 | This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available. Start: 1/1/1997 |
| M29 | Missing operative note/report. Start: 1/1/1997 | Last Modified: 7/1/2008 Note: (Modified 2/28/03, 7/1/2008) Related to N233 |
| M30 | Missing pathology report. Start: 1/1/1997 | Last Modified: 8/1/2004 Note: (Modified 8/1/04, 2/28/03) Related to N236 |
| M31 | Missing radiology report. Start: 1/1/1997 | Last Modified: 8/1/2004 Note: (Modified 8/1/04, 2/28/03) Related to N240 |
| M32 | Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| M33 | Missing/incomplete/invalid UPIN for the ordering/referring/performing provider. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using M68 |
| M34 | Claim lacks the CLIA certification number. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using MA120 |
| M35 | Missing/incomplete/invalid pre-operative photos or visual field results. Start: 1/1/1997 | Stop: 2/5/2005 Note: Consider using N178 |
| M36 | This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase. Start: 1/1/1997 |
| M37 | Service not covered when the patient is under age 35. Start: 1/1/1997 |
| M38 | The patient is liable for the charges for this service as you informed the patient in writing before the service was furnished that we would not pay for it, and the patient agreed to pay. Start: 1/1/1997 |
| M39 | Alert: The patient is not liable for payment for this service as the advance notice of non-coverage you provided the patient did not comply with program requirements. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 2/1/04, 4/1/07) |
| M40 | Claim must be assigned and must be filed by the practitioner's employer. Start: 1/1/1997 |
| M41 | We do not pay for this as the patient has no legal obligation to pay for this. Start: 1/1/1997 |
| M42 | The medical necessity form must be personally signed by the attending physician. Start: 1/1/1997 |
| M43 | Payment for this service previously issued to you or another provider by another carrier/intermediary. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using Reason Code 23 |
| M44 | Missing/incomplete/invalid condition code. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M45 | Missing/incomplete/invalid occurrence code(s). Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) Related to N299 |
| M46 | Missing/incomplete/invalid occurrence span code(s). Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) Related to N300 |
| M47 | Missing/incomplete/invalid internal or document control number. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M48 | Payment for services furnished to hospital inpatients (other than professional services of physicians) can only be made to the hospital. You must request payment from the hospital rather than the patient for this service. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using M97 |
| M49 | Missing/incomplete/invalid value code(s) or amount(s). Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M50 | Missing/incomplete/invalid revenue code(s). Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M51 | Missing/incomplete/invalid procedure code(s). Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) Related to N301 |
| M52 | Missing/incomplete/invalid “from” date(s) of service. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M53 | Missing/incomplete/invalid days or units of service. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M54 | Missing/incomplete/invalid total charges. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M55 | We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug. Start: 1/1/1997 |
| M56 | Missing/incomplete/invalid payer identifier. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M57 | Missing/incomplete/invalid provider identifier. Start: 1/1/1997 | Stop: 6/2/2005 |
| M58 | Missing/incomplete/invalid claim information. Resubmit claim after corrections. Start: 1/1/1997 | Stop: 2/5/2005 |
| M59 | Missing/incomplete/invalid “to” date(s) of service. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M60 | Missing Certificate of Medical Necessity. Start: 1/1/1997 | Last Modified: 8/1/2004 Note: (Modified 8/1/04, 6/30/03) Related to N227 |
| M61 | We cannot pay for this as the approval period for the FDA clinical trial has expired. Start: 1/1/1997 |
| M62 | Missing/incomplete/invalid treatment authorization code. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M63 | We do not pay for more than one of these on the same day. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using M86 |
| M64 | Missing/incomplete/invalid other diagnosis. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M65 | One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician. Start: 1/1/1997 |
| M66 | Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items. Start: 1/1/1997 |
| M67 | Missing/incomplete/invalid other procedure code(s). Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) Related to N302 |
| M68 | Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification. Start: 1/1/1997 | Stop: 6/2/2005 |
| M69 | Paid at the regular rate as you did not submit documentation to justify the modified procedure code. Start: 1/1/1997 | Last Modified: 2/1/2004 Note: (Modified 2/1/04) |
| M70 | Alert: The NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item. Start: 1/1/1997 | Last Modified: 8/1/2007 Note: (Modified 4/1/2007, 8/1/07) |
| M71 | Total payment reduced due to overlap of tests billed. Start: 1/1/1997 |
| M72 | Did not enter full 8-digit date (MM/DD/CCYY). Start: 1/1/1997 | Stop: 10/16/2003 Note: Consider using MA52 |
| M73 | The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components. Start: 1/1/1997 | Last Modified: 8/1/2004 Note: (Modified 8/1/04) |
| M74 | This service does not qualify for a HPSA/Physician Scarcity bonus payment. Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) |
| M75 | Multiple automated multichannel tests performed on the same day combined for payment. Start: 1/1/1997 | Last Modified: 11/5/2007 Note: (Modified 11/5/07) |
| M76 | Missing/incomplete/invalid diagnosis or condition. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M77 | Missing/incomplete/invalid place of service. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M78 | Missing/incomplete/invalid HCPCS modifier. Start: 1/1/1997 | Stop: 5/18/2006 | Last Modified: 2/28/2003 Note: (Modified 2/28/03,) Consider using Reason Code 4 |
| M79 | Missing/incomplete/invalid charge. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M80 | Not covered when performed during the same session/date as a previously processed service for the patient. Start: 1/1/1997 | Last Modified: 10/31/2002 Note: (Modified 10/31/02) |
| M81 | You are required to code to the highest level of specificity. Start: 1/1/1997 | Last Modified: 2/1/2004 Note: (Modified 2/1/04) |
| M82 | Service is not covered when patient is under age 50. Start: 1/1/1997 |
| M83 | Service is not covered unless the patient is classified as at high risk. Start: 1/1/1997 |
| M84 | Medical code sets used must be the codes in effect at the time of service Start: 1/1/1997 | Last Modified: 2/1/2004 Note: (Modified 2/1/04) |
| M85 | Subjected to review of physician evaluation and management services. Start: 1/1/1997 |
| M86 | Service denied because payment already made for same/similar procedure within set time frame. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| M87 | Claim/service(s) subjected to CFO-CAP prepayment review. Start: 1/1/1997 |
| M88 | We cannot pay for laboratory tests unless billed by the laboratory that did the work. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using Reason Code B20 |
| M89 | Not covered more than once under age 40. Start: 1/1/1997 |
| M90 | Not covered more than once in a 12 month period. Start: 1/1/1997 |
| M91 | Lab procedures with different CLIA certification numbers must be billed on separate claims. Start: 1/1/1997 |
| M92 | Services subjected to review under the Home Health Medical Review Initiative. Start: 1/1/1997 | Stop: 8/1/2004 |
| M93 | Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment. Start: 1/1/1997 |
| M94 | Information supplied does not support a break in therapy. A new capped rental period will not begin. Start: 1/1/1997 |
| M95 | Services subjected to Home Health Initiative medical review/cost report audit. Start: 1/1/1997 |
| M96 | The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only. Start: 1/1/1997 |
| M97 | Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility. Start: 1/1/1997 |
| M98 | Begin to report the Universal Product Number on claims for items of this type. We will soon begin to deny payment for items of this type if billed without the correct UPN. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using M99 |
| M99 | Missing/incomplete/invalid Universal Product Number/Serial Number. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M100 | We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug. Start: 1/1/1997 |
| M101 | Begin to report a G1-G5 modifier with this HCPCS. We will soon begin to deny payment for this service if billed without a G1-G5 modifier. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using M78 |
| M102 | Service not performed on equipment approved by the FDA for this purpose. Start: 1/1/1997 |
| M103 | Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment. Start: 1/1/1997 |
| M104 | Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service. Start: 1/1/1997 |
| M105 | Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin. Start: 1/1/1997 |
| M106 | Information supplied does not support a break in therapy. A new capped rental period will not begin. This is the maximum approved under the fee schedule for this item or service. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using MA 31 |
| M107 | Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%. Start: 1/1/1997 |
| M108 | Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test. Start: 1/1/1997 | Stop: 6/2/2005 |
| M109 | We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner. Start: 1/1/1997 |
| M110 | Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services. Start: 1/1/1997 | Stop: 6/2/2005 |
| M111 | We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken. Start: 1/1/1997 |
| M112 | Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides. Start: 1/1/1997 | Last Modified: 11/5/2007 Note: (Modified 11/5/07) |
| M113 | Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program. Start: 1/1/1997 | Last Modified: 11/5/2007 Note: (Modified 11/5/07) |
| M114 | This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor. Start: 1/1/1997 | Last Modified: 11/5/2007 Note: (Modified 8/1/06, 11/5/07) |
| M115 | This item is denied when provided to this patient by a non-contract or non-demonstration supplier. Start: 1/1/1997 | Last Modified: 11/5/2007 Note: (Modified 11/5/2007) |
| M116 | Paid under the Competitive Bidding Demonstration project. Project is ending, and future services may not be paid under this project. Start: 1/1/1997 | Last Modified: 2/1/2004 Note: (Modified 2/1/04) |
| M117 | Not covered unless submitted via electronic claim. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| M118 | Alert: Letter to follow containing further information. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| M119 | Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC). Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 2/28/03, 4/1/04) |
| M120 | Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens arrangement. Start: 1/1/1997 | Stop: 6/2/2005 |
| M121 | We pay for this service only when performed with a covered cryosurgical ablation. Start: 1/1/1997 |
| M122 | Missing/incomplete/invalid level of subluxation. Start: 1/1/1997 | Last Modified: 2/28/2006 Note: (Modified 2/28/03) |
| M123 | Missing/incomplete/invalid name, strength, or dosage of the drug furnished. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M124 | Missing indication of whether the patient owns the equipment that requires the part or supply. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N230 |
| M125 | Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M126 | Missing/incomplete/invalid individual lab codes included in the test. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M127 | Missing patient medical record for this service. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N237 |
| M128 | Missing/incomplete/invalid date of the patient’s last physician visit. Start: 1/1/1997 | Stop: 6/2/2005 |
| M129 | Missing/incomplete/invalid indicator of x-ray availability for review. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 2/28/03, 6/30/03) |
| M130 | Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N231 |
| M131 | Missing physician financial relationship form. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N239 |
| M132 | Missing pacemaker registration form. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N235 |
| M133 | Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test. Start: 1/1/1997 |
| M134 | Performed by a facility/supplier in which the provider has a financial interest. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| M135 | Missing/incomplete/invalid plan of treatment. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M136 | Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| M137 | Part B coinsurance under a demonstration project. Start: 1/1/1997 |
| M138 | Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants. Start: 1/1/1997 |
| M139 | Denied services exceed the coverage limit for the demonstration. Start: 1/1/1997 |
| M140 | Service not covered until after the patient’s 50th birthday, i.e., no coverage prior to the day after the 50th birthday Start: 1/1/1997 | Stop: 1/30/2004 Note: Consider using M82 |
| M141 | Missing physician certified plan of care. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N238 |
| M142 | Missing American Diabetes Association Certificate of Recognition. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N226 |
| M143 | The provider must update license information with the payer. Start: 1/1/1997 | Last Modified: 12/1/2006 Note: (Modified 12/1/06) |
| M144 | Pre-/post-operative care payment is included in the allowance for the surgery/procedure. Start: 1/1/1997 |
| MA01 | Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07) |
| MA02 | Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07) |
| MA03 | If you do not agree with the approved amounts and $100 or more is in dispute (less deductible and coinsurance), you may ask for a hearing within six months of the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time. Start: 1/1/1997 | Stop: 10/1/2006 | Last Modified: 11/18/2005 Note: Consider using MA02 (Modified 10/31/02, 6/30/03, 8/1/05, 11/18/05) |
| MA04 | Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible. Start: 1/1/1997 |
| MA05 | Incorrect admission date patient status or type of bill entry on claim. Start: 1/1/1997 | Stop: 10/16/2003 Note: Consider using MA30, MA40 or MA43 |
| MA06 | Missing/incomplete/invalid beginning and/or ending date(s). Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using MA31 |
| MA07 | Alert: The claim information has also been forwarded to Medicaid for review. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA08 | Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA09 | Claim submitted as unassigned but processed as assigned. You agreed to accept assignment for all claims. Start: 1/1/1997 |
| MA10 | Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA11 | Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using M32 |
| MA12 | You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s). Start: 1/1/1997 |
| MA13 | Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA14 | Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services. Start: 1/1/1997 | Last Modified: 8/1/2007 Note: (Modified 4/1/07, 8/1/07) |
| MA15 | Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA16 | The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703. Start: 1/1/1997 |
| MA17 | We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment. Start: 1/1/1997 |
| MA18 | Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA19 | Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA20 | Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| MA21 | SSA records indicate mismatch with name and sex. Start: 1/1/1997 |
| MA22 | Payment of less than $1.00 suppressed. Start: 1/1/1997 |
| MA23 | Demand bill approved as result of medical review. Start: 1/1/1997 |
| MA24 | Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| MA25 | A patient may not elect to change a hospice provider more than once in a benefit period. Start: 1/1/1997 |
| MA26 | Alert: Our records indicate that you were previously informed of this rule. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA27 | Missing/incomplete/invalid entitlement number or name shown on the claim. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA28 | Alert: Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA29 | Missing/incomplete/invalid provider name, city, state, or zip code. Start: 1/1/1997 | Stop: 6/2/2005 |
| MA30 | Missing/incomplete/invalid type of bill. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA31 | Missing/incomplete/invalid beginning and ending dates of the period billed. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA32 | Missing/incomplete/invalid number of covered days during the billing period. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA33 | Missing/incomplete/invalid noncovered days during the billing period. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA34 | Missing/incomplete/invalid number of coinsurance days during the billing period. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA35 | Missing/incomplete/invalid number of lifetime reserve days. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA36 | Missing/incomplete/invalid patient name. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA37 | Missing/incomplete/invalid patient's address. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA38 | Missing/incomplete/invalid birth date. Start: 1/1/1997 | Stop: 6/2/2005 |
| MA39 | Missing/incomplete/invalid gender. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA40 | Missing/incomplete/invalid admission date. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA41 | Missing/incomplete/invalid admission type. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA42 | Missing/incomplete/invalid admission source. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA43 | Missing/incomplete/invalid patient status. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA44 | Alert: No appeal rights. Adjudicative decision based on law. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA45 | Alert: As previously advised, a portion or all of your payment is being held in a special account. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA46 | The new information was considered, however, additional payment cannot be issued. Please review the information listed for the explanation. Start: 1/1/1997 |
| MA47 | Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment. Start: 1/1/1997 |
| MA48 | Missing/incomplete/invalid name or address of responsible party or primary payer. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA49 | Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using MA76 |
| MA50 | Missing/incomplete/invalid Investigational Device Exemption number for FDA-approved clinical trial services. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA51 | Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory. Start: 1/1/1997 | Stop: 2/5/2005 Note: Consider using MA120 |
| MA52 | Missing/incomplete/invalid date. Start: 1/1/1997 | Stop: 6/2/2005 |
| MA53 | Missing/incomplete/invalid Competitive Bidding Demonstration Project identification. Start: 1/1/1997 | Last Modified: 2/1/2004 Note: (Modified 2/1/04) |
| MA54 | Physician certification or election consent for hospice care not received timely. Start: 1/1/1997 |
| MA55 | Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services. Start: 1/1/1997 |
| MA56 | Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount. Start: 1/1/1997 |
| MA57 | Patient submitted written request to revoke his/her election for religious non-medical health care services. Start: 1/1/1997 |
| MA58 | Missing/incomplete/invalid release of information indicator. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA59 | Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA60 | Missing/incomplete/invalid patient relationship to insured. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA61 | Missing/incomplete/invalid social security number or health insurance claim number. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA62 | Alert: This is a telephone review decision. Start: 1/1/1997 | Last Modified: 8/1/2007 Note: (Modified 4/1/07, 8/1/07) |
| MA63 | Missing/incomplete/invalid principal diagnosis. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA64 | Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers. Start: 1/1/1997 |
| MA65 | Missing/incomplete/invalid admitting diagnosis. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA66 | Missing/incomplete/invalid principal procedure code. Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) Related to N303 |
| MA67 | Correction to a prior claim. Start: 1/1/1997 |
| MA68 | Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA69 | Missing/incomplete/invalid remarks. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA70 | Missing/incomplete/invalid provider representative signature. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA71 | Missing/incomplete/invalid provider representative signature date. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA72 | Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA73 | Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care. Start: 1/1/1997 |
| MA74 | This payment replaces an earlier payment for this claim that was either lost, damaged or returned. Start: 1/1/1997 |
| MA75 | Missing/incomplete/invalid patient or authorized representative signature. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA76 | Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03, 2/1/04) |
| MA77 | Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient’s payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice. Start: 1/1/1997 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| MA78 | The patient overpaid you. You must issue the patient a refund within 30 days for the difference between our allowed amount total and the amount paid by the patient. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using MA59 |
| MA79 | Billed in excess of interim rate. Start: 1/1/1997 |
| MA80 | Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project. Start: 1/1/1997 |
| MA81 | Missing/incomplete/invalid provider/supplier signature. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA82 | Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number. Start: 1/1/1997 | Stop: 6/2/2005 |
| MA83 | Did not indicate whether we are the primary or secondary payer. Start: 1/1/1997 | Last Modified: 8/1/2005 Note: (Modified 8/1/05) |
| MA84 | Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy. Start: 1/1/1997 |
| MA85 | Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program name or identification number. Enter the PlanID when effective. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using MA92 |
| MA86 | Missing/incomplete/invalid group or policy number of the insured for the primary coverage. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using MA92 |
| MA87 | Missing/incomplete/invalid insured's name for the primary payer. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using MA92 |
| MA88 | Missing/incomplete/invalid insured's address and/or telephone number for the primary payer. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA89 | Missing/incomplete/invalid patient's relationship to the insured for the primary payer. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA90 | Missing/incomplete/invalid employment status code for the primary insured. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03). |
| MA91 | This determination is the result of the appeal you filed. Start: 1/1/1997 |
| MA92 | Missing plan information for other insurance. Start: 1/1/1997 | Last Modified: 2/1/2004 Note: (Modified 2/1/04) Related to N245 |
| MA93 | Non-PIP (Periodic Interim Payment) claim. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| MA94 | Did not enter the statement “Attending physician not hospice employee” on the claim form to certify that the rendering physician is not an employee of the hospice. Start: 1/1/1997 | Last Modified: 8/1/2005 Note: (Reactivated 4/1/04, Modified 8/1/05) |
| MA95 | De-activate and refer to M51. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA96 | Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan. Start: 1/1/1997 |
| MA97 | Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number. Start: 1/1/1997 | Last Modified: 2/29/2008 Note: (Modified 2/29/08) |
| MA98 | Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary. Start: 1/1/1997 | Stop: 10/16/2003 Note: Consider using MA97 |
| MA99 | Missing/incomplete/invalid Medigap information. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA100 | Missing/incomplete/invalid date of current illness or symptoms Start: 1/1/1997 | Last Modified: 3/30/2005 Note: (Modified 2/28/03, 3/30/05) |
| MA101 | A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| MA102 | Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider. Start: 1/1/1997 | Stop: 8/1/2004 Note: Consider using M68 |
| MA103 | Hemophilia Add On. Start: 1/1/1997 |
| MA104 | Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using M128 or M57 |
| MA105 | Missing/incomplete/invalid provider number for this place of service. Start: 1/1/1997 | Stop: 6/2/2005 |
| MA106 | PIP (Periodic Interim Payment) claim. Start: 1/1/1997 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| MA107 | Paper claim contains more than three separate data items in field 19. Start: 1/1/1997 |
| MA108 | Paper claim contains more than one data item in field 23. Start: 1/1/1997 |
| MA109 | Claim processed in accordance with ambulatory surgical guidelines. Start: 1/1/1997 |
| MA110 | Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA111 | Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA112 | Missing/incomplete/invalid group practice information. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA113 | Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN. Start: 1/1/1997 |
| MA114 | Missing/incomplete/invalid information on where the services were furnished. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA115 | Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA). Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA116 | Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution. Start: 1/1/1997 Note: (Reactivated 4/1/04) |
| MA117 | This claim has been assessed a $1.00 user fee. Start: 1/1/1997 |
| MA118 | Coinsurance and/or deductible amounts apply to a claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. No Medicare payment issued. Start: 1/1/1997 |
| MA119 | Provider level adjustment for late claim filing applies to this claim. Start: 1/1/1997 | Stop: 5/1/2008 | Last Modified: 11/5/2007 Note: Consider using Reason Code B4 |
| MA120 | Missing/incomplete/invalid CLIA certification number. Start: 1/1/1997 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| MA121 | Missing/incomplete/invalid x-ray date. Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) |
| MA122 | Missing/incomplete/invalid initial treatment date. Start: 1/1/1997 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) |
| MA123 | Your center was not selected to participate in this study, therefore, we cannot pay for these services. Start: 1/1/1997 |
| MA124 | Processed for IME only. Start: 1/1/1997 | Stop: 1/31/2004 Note: Consider using Reason Code 74 |
| MA125 | Per legislation governing this program, payment constitutes payment in full. Start: 1/1/1997 |
| MA126 | Pancreas transplant not covered unless kidney transplant performed. Start: 10/12/2001 |
| MA127 | Reserved for future use. Start: 10/12/2001 | Stop: 6/2/2005 |
| MA128 | Missing/incomplete/invalid FDA approval number. Start: 10/12/2001 | Last Modified: 3/30/2005 Note: (Modified 2/28/03, 3/30/05) |
| MA129 | This provider was not certified for this procedure on this date of service. Start: 10/12/2001 | Stop: 1/31/2004 | Last Modified: 1/31/2004 Note: Consider using MA120 and Reason Code B7 |
| MA130 | Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information. Start: 10/12/2001 |
| MA131 | Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim. Start: 10/12/2001 |
| MA132 | Adjustment to the pre-demonstration rate. Start: 10/12/2001 |
| MA133 | Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay. Start: 10/12/2001 |
| MA134 | Missing/incomplete/invalid provider number of the facility where the patient resides. Start: 10/12/2001 |
| N1 | Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 2/28/03, 4/1/07) |
| N2 | This allowance has been made in accordance with the most appropriate course of treatment provision of the plan. Start: 1/1/2000 |
| N3 | Missing consent form. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) Related to N228 |
| N4 | Missing/incomplete/invalid prior insurance carrier EOB. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N5 | EOB received from previous payer. Claim not on file. Start: 1/1/2000 |
| N6 | Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N7 | Processing of this claim/service has included consideration under Major Medical provisions. Start: 1/1/2000 |
| N8 | Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication. Start: 1/1/2000 |
| N9 | Adjustment represents the estimated amount a previous payer may pay. Start: 1/1/2000 | Last Modified: 11/18/2005 Note: (Modified 11/18/05) |
| N10 | Payment based on the findings of a review organization/professional consult/manual adjudication/medical or dental advisor. Start: 1/1/2000 | Last Modified: 7/1/2008 Note: (Modified 10/31/02, 7/1/08) |
| N11 | Denial reversed because of medical review. Start: 1/1/2000 |
| N12 | Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare. Start: 1/1/2000 | Last Modified: 8/1/2007 Note: (Modified 8/1/07) |
| N13 | Payment based on professional/technical component modifier(s). Start: 1/1/2000 |
| N14 | Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount. Start: 1/1/2000 | Stop: 10/1/2007 Note: Consider using Reason Code 45 |
| N15 | Services for a newborn must be billed separately. Start: 1/1/2000 |
| N16 | Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage. Start: 1/1/2000 |
| N17 | Per admission deductible. Start: 1/1/2000 | Stop: 8/1/2004 Note: Consider using Reason Code 1 |
| N18 | Payment based on the Medicare allowed amount. Start: 1/1/2000 | Stop: 1/31/2004 Note: Consider using N14 |
| N19 | Procedure code incidental to primary procedure. Start: 1/1/2000 |
| N20 | Service not payable with other service rendered on the same date. Start: 1/1/2000 |
| N21 | Alert: Your line item has been separated into multiple lines to expedite handling. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 8/1/05, 4/1/07) |
| N22 | This procedure code was added/changed because it more accurately describes the services rendered. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 10/31/02, 2/28/03) |
| N23 | Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 8/13/01, 4/1/07) |
| N24 | Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N25 | This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan. Start: 1/1/2000 |
| N26 | Missing itemized bill/statement. Start: 1/1/2000 | Last Modified: 7/1/2008 Note: (Modified 2/28/03, 7/1/2008) Related to N232 |
| N27 | Missing/incomplete/invalid treatment number. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N28 | Consent form requirements not fulfilled. Start: 1/1/2000 |
| N29 | Missing documentation/orders/notes/summary/report/chart. Start: 1/1/2000 | Last Modified: 8/1/2005 Note: (Modified 2/28/03, 8/1/05) Related to N225 |
| N30 | Patient ineligible for this service. Start: 1/1/2000 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| N31 | Missing/incomplete/invalid prescribing provider identifier. Start: 1/1/2000 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) |
| N32 | Claim must be submitted by the provider who rendered the service. Start: 1/1/2000 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| N33 | No record of health check prior to initiation of treatment. Start: 1/1/2000 |
| N34 | Incorrect claim form/format for this service. Start: 1/1/2000 | Last Modified: 11/18/2005 Note: (Modified 11/18/05) |
| N35 | Program integrity/utilization review decision. Start: 1/1/2000 |
| N36 | Claim must meet primary payer’s processing requirements before we can consider payment. Start: 1/1/2000 |
| N37 | Missing/incomplete/invalid tooth number/letter. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N38 | Missing/incomplete/invalid place of service. Start: 1/1/2000 | Stop: 2/5/2005 Note: Consider using M77 |
| N39 | Procedure code is not compatible with tooth number/letter. Start: 1/1/2000 |
| N40 | Missing radiology film(s)/image(s). Start: 1/1/2000 | Last Modified: 7/1/2008 Note: (Modified 2/1/04, 7/1/08) Related to N242 |
| N41 | Authorization request denied. Start: 1/1/2000 | Stop: 10/16/2003 Note: Consider using Reason Code 39 |
| N42 | No record of mental health assessment. Start: 1/1/2000 |
| N43 | Bed hold or leave days exceeded. Start: 1/1/2000 |
| N44 | Payer’s share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority. Start: 1/1/2000 | Stop: 10/16/2003 Note: Consider using Reason Code 137 |
| N45 | Payment based on authorized amount. Start: 1/1/2000 |
| N46 | Missing/incomplete/invalid admission hour. Start: 1/1/2000 |
| N47 | Claim conflicts with another inpatient stay. Start: 1/1/2000 |
| N48 | Claim information does not agree with information received from other insurance carrier. Start: 1/1/2000 |
| N49 | Court ordered coverage information needs validation. Start: 1/1/2000 |
| N50 | Missing/incomplete/invalid discharge information. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N51 | Electronic interchange agreement not on file for provider/submitter. Start: 1/1/2000 |
| N52 | Patient not enrolled in the billing provider's managed care plan on the date of service. Start: 1/1/2000 |
| N53 | Missing/incomplete/invalid point of pick-up address. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N54 | Claim information is inconsistent with pre-certified/authorized services. Start: 1/1/2000 |
| N55 | Procedures for billing with group/referring/performing providers were not followed. Start: 1/1/2000 |
| N56 | Procedure code billed is not correct/valid for the services billed or the date of service billed. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N57 | Missing/incomplete/invalid prescribing date. Start: 1/1/2000 | Last Modified: 12/2/2004 Note: (Modified 12/2/04) Related to N304 |
| N58 | Missing/incomplete/invalid patient liability amount. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N59 | Alert: Please refer to your provider manual for additional program and provider information. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| N60 | A valid NDC is required for payment of drug claims effective October 02. Start: 1/1/2000 | Stop: 1/31/2004 Note: Consider using M119 |
| N61 | Rebill services on separate claims. Start: 1/1/2000 |
| N62 | Inpatient admission spans multiple rate periods. Resubmit separate claims. Start: 1/1/2000 |
| N63 | Rebill services on separate claim lines. Start: 1/1/2000 |
| N64 | The “from” and “to” dates must be different. Start: 1/1/2000 |
| N65 | Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N66 | Missing/incomplete/invalid documentation. Start: 1/1/2000 | Stop: 2/5/2005 Note: Consider using N29 or N225. |
| N67 | Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient’s admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim. Start: 1/1/2000 |
| N68 | Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days. Start: 1/1/2000 |
| N69 | PPS (Prospective Payment System) code changed by claims processing system. Insufficient visits or therapies. Start: 1/1/2000 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| N70 | Consolidated billing and payment applies. Start: 1/1/2000 | Last Modified: 11/5/2007 Note: (Modified 2/28/02, 11/5/07) |
| N71 | Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims. Start: 1/1/2000 | Last Modified: 6/30/2003 Note: (Modified 2/21/02, 6/30/03) |
| N72 | PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records. Start: 1/1/2000 | Last Modified: 6/30/2003 Note: (Modified 6/30/03) |
| N73 | A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents. Start: 1/1/2000 | Stop: 1/31/2004 Note: Consider using MA101 or N200 |
| N74 | Resubmit with multiple claims, each claim covering services provided in only one calendar month. Start: 1/1/2000 |
| N75 | Missing/incomplete/invalid tooth surface information. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N76 | Missing/incomplete/invalid number of riders. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N77 | Missing/incomplete/invalid designated provider number. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N78 | The necessary components of the child and teen checkup (EPSDT) were not completed. Start: 1/1/2000 |
| N79 | Service billed is not compatible with patient location information. Start: 1/1/2000 |
| N80 | Missing/incomplete/invalid prenatal screening information. Start: 1/1/2000 | Last Modified: 2/28/2003 Note: (Modified 2/28/03) |
| N81 | Procedure billed is not compatible with tooth surface code. Start: 1/1/2000 |
| N82 | Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement. Start: 1/1/2000 |
| N83 | No appeal rights. Adjudicative decision based on the provisions of a demonstration project. Start: 1/1/2000 |
| N84 | Alert: Further installment payments are forthcoming. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 4/1/07, 8/1/07) |
| N85 | Alert: This is the final installment payment. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 4/1/07, 8/1/07) |
| N86 | A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered. Start: 1/1/2000 |
| N87 | Home use of biofeedback therapy is not covered. Start: 1/1/2000 |
| N88 | Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| N89 | Alert: Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice. Start: 1/1/2000 | Last Modified: 4/1/2007 Note: (Modified 4/1/07) |
| N90 | Covered only when performed by the attending physician. Start: 1/1/2000 |
| N91 | Services not included in the appeal review. Start: 1/1/2000 |