Reason Code Narrative

A DDE/EMC OUTPATIENT CLAIM HAS A LINE(S) WITH PROVIDER SUBMITTED NON-COVERED CHARGES ARE GREATER THAN ZERO AND ARE EQUAL TO THE TOTAL CHARGES, AND CONDITION CODE 20 OR 21 OR OCCURRENCE CODE 32 IS NOT PRESENT.

Common Reason Code Errors

Condition code (CC) 20, 21 or occurrence code (OC) 32 is not present on the claim to indicate the non-covered reason.

• OC 32 = Advance Beneficiary Notice (ABN) given; report with appropriate liability-related modifier & covered charges
• CC 20 = Demand bill will be reviewed
• CC 21 = No-payment, automatically process

Common Reason Code Corrections

• This is a valid processing reason code. It does not reflect incorrect billing.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 60.4.2

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