Bundling/Not Separately Payable

CARC/RARC DESCRIPTION
CO-B15 This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
M80 Not covered when performed during the same session/date as a previously processed service for this patient.

 

Common Reasons for Message

  • Combination of codes billed on same date of service by same provider may not be appropriately paired together due to National Correct Coding Initiative (NCCI) Edits
    • Payment for service billed is bundled into payment for another service performed that day
    • It is unusual for services billed to be performed together
  • Modifier used to unbundle is on incorrect code or incorrect modifier was used

Next Step

  • Verify code set is appropriate to be billed together
  • Submit Appeal request to add modifier, if appropriate
    • See Appeals webpage for instructions on how to submit a Reopening or Redetermination

Claim Submission Tips

  • Review NCCI Coding Edits prior to submitting claim to determine if codes are appropriately paired
  • When appropriate, modifier to identify separately identifiable service should be appended to Column 2 code
    • Modifier Indicator "0" - there are no circumstances in which both procedures of a code pair should be paid; modifier is not allowed for NCCI purposes
    • Modifier Indicator "1" - modifiers associated with NCCI are allowed with this code pair when appropriate
    • Modifier Indicator "9" - NCCI edit does not apply to this code pair; edit for code pair was deleted retroactively
  • Providers may not bill patient for NCCI edit denials
    • Denial is based on incorrect coding
    • Providers should not complete an ABN for NCCI edits

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

Last Updated Aug 24, 2018