Routine Service - JE Part B
Routine Service
| CARC/RARC | Description |
|---|---|
| PR-49 | This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| N111 | This service was included in a claim that has been previously billed and adjudicated. |
| N429 | Not covered when considered routine. |
Common Reasons for Message
- Claim was billed with a routine diagnosis as the primary diagnosis
- Diagnosis codes starting with the letter 'Z' are routine diagnosis.
Next Step
- Verify proper diagnosis was submitted
- Claims can be reopened with a more appropriate primary diagnosis
- Submit an Appeal request - Items or services with this message have appeal rights
- Submit documentation with Redetermination request. View Medical Documentation Requirements
Claim Submission Tips
- Allow 30 days from first claim submission before resubmitting
- Check claim status via Interactive Voice Response (IVR) or the Noridian Medicare Portal
Last Updated Dec 09 , 2023
