Reason Code Narrative

WHEN TOB EQUALS 12X, 13X, 22X, 23X, 24x, 34X, 71X, 72X, 75X, 77X, 83X, 85X, DIAGNOSIS CODE Z23 IS PRESENT AND THE CLAIM DOSE NOT CONTAIN CONDITION CODE A6.

Common Reason Code Errors

• Claim contains diagnosis code Z23, but condition code A6 is not present.

Common Reason Code Corrections

• If the vaccine is one of the following: influenza, pneumococcal, hepatitis B, or COVID-19 and the diagnosis code is Z23, add Condition Code A6 to the claim.
• If the vaccine is not one listed above, do not add Condition Code A6 or diagnosis code Z23.

Resource

• CMS Internet Only Manual (IOM), Publication 100-4, Chapter 18, Section 10.2.1
• CMS Change Request (CR) 14396

View reason code list, return to Reason Code Guidance page.