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.

 

Common Reasons for Message

  • Routine examinations and related services are not covered.

Next Step

  • Verify proper diagnosis was submitted
  • Submit an Appeal request - Items or services with this message have appeal rights

Claim Submission Tips

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

 

Last Updated Nov 15, 2017