Reason Code W7009 - JF Part A

Reason Code Narrative

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

Common Reason Code Errors

• The claim line item(s) submitted with service(s) that Medicare does not cover.
  • E.g., Category II HCPCS that is not payable.

Common Reason Code Corrections

• The claim line item denial was processed correctly and no corrections needed.

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

Resources

• CMS Medicare Learning Network MLN906765 - Items & Services Not Covered Under Medicare
• CMS Bundled Payments for Care Improvement (BPCI) Advanced - Quality Measures - Questions and Answers (QAs) Updated: July 2023
• CMS Internet Only Manual (IOM), Publication 100-22, Medicare Quality Reporting Incentive Programs Manual, Chapter 1 - The Physician Quality Reporting Initiative (PQR)
• CMS Medicare Learning Network (MLN) Matters: MM11259 - Reporting the HCPCS Level II Modifiers of the Patient Relationship Categories and Codes
• CMS Quality Payment Program - MIPS Participation Fact Sheet

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