Reason Code Narrative

An outpatient claim (13x, 14x, and 85x) for lab services for ESRD consolidated billing services with dates of service overlapping or within the Covered ESRD outpatient claim (72x).

Common Reason Code Errors

• Modifier missing that would exclude services from ESRD consolidated billing
• Missing 045x revenue code (Emergency Room)

Common Reason Code Corrections

Verify date(s) of service. Determine whether any of the following is appropriate for the claim:

• Was the item/service provided in the emergency room? Consider revenue code 045x and/or ET modifier
• Was the item/service related to the treatment of ESRD? If not, consider modifier AY
• Is the claim meant to be paid? If not, use the xx0 type of bill

If you require additional information on the other claim, including facility information, check out the Denial Details tab for the denied claim in the Noridian Medicare Portal. Use the Interactive Voice Response (IVR) system or call the Provider Contact Center for additional claim information.

To view Noridian’s reason code list, return to Reason Code Guidance page.