Reason Code Narrative

NON-COVERED UNDER ANY MEDICARE OUTPATIENT
BENEFIT, FOR REASONS OTHER THAN STATUTORY EXCLUSION

Common Reason Code Errors

• Service(s) that Medicare does not cover were submitted on the claim

Common Reason Code Corrections

• Verify coverage determinations in Internet Only Manual (IOM), National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), CPT and HCPC descriptions
• A Redetermination may be submitted if the facility feels that sending additional documentation will support the need for service(s) provided.
  • Redetermination should include:
    • All applicable supporting medical documentation
    • Corrected UB-04 form

Direct Data Entry (DDE) users can view the remarks section for additional clarification.

Resources

• CMS Definitions of Medicare Code Edits
• CMS Integrated Outpatient Code Editor (IOCE)
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 25

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