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Self Service Denial Assistance is Available with the More Info Button
You currently have jurisdiction selected, however this page only applies to these jurisdiction(s): .
Use the table below to determine if your denial reason code has more information available. Then, log in or register for a WPS Government Health Administrators Portal account to use the More Info feature. See Portal User Manual – Claim Status to learn more.
Part A Claim Category | Additional Information available in More Info | Part A Reason Codes |
---|---|---|
Add-on Code without Primary Procedure Code | Link to Add-on Code Edits page on CMS website | W7106, W7107, W7108, W7084 |
Adjustment of a Previously Adjusted Claim | 30912 | |
Adjustment with no Original Claim on File | 30902, 30905, 30906 | |
Adjustment Submitted with Condition Code D9 with No Remarks | 37541 | |
Admit Date Prior to From Date | U5606 | |
Annual Wellness Visit (AWV) | Link to AWV booklet on CMS website | U5273, U5274, U5275, U5276, U5310 |
Beneficiary Eligibility | U5200, U5210, U5220 | |
Benefits Exhausted | 39510 | |
Benefits Exhaust SNF | 39508 | |
Condition Codes MO-MZ Changed by Submitter |
30008 | |
Cost Report Days and Accommodation Units Mismatch | 37025 | |
Date of Service Overlap Denials - Inpatient | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status | C7252, C7080, C7050, C7279, C729C, 75601, 38002, 38017, 38018, 38019, 38020, 38022, 38086, 38108, 38112, 38115, U5601, U7080 |
Date of Service Overlap Denials - Outpatient | Outpatient Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 38024 |
Diagnosis May Be No Fault, Workers Comp or Liability | Insurer Name and Address, Effective and Term Date, MSP Type | 39074 |
Documentation Not Received Timely | 39721 | |
Duplicate Denials - Inpatient | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 38001, 38004, 38005, 38007, 38013, 38023 |
Duplicate Denials - Outpatient | Outpatient Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 30919, 38025, 38026, 38031, 38032, 38034, 38035, 38037, 38038, 38052, 38054, 38061, 38067, 38070, 38072, 38076, 38077, 38092, 38097, 38105, 38109, 38111, 38113, 38130, 38135, 38136, 38137, 38138, 38139, 38149, 38151, 38152, 38153, 38154, 38155, 38159, 38200, 38308, 38312, C7055, C7112, C7253, C7254, C7255 |
Duplicate 3D Conformal Radiation Therapy Planning Services | C7715 | |
ESRD Consolidated Billing | Outpatient Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 10422, C7565, 10423, C7566, C729A |
HICN Submitted after 01/01/2020 | 30995 | |
Home Health Denials | Home Health NPI, Patient Status, Start and End Date, Earliest and Latest Billing Action Dates | U5390 |
Hospice Enrollment Denials | Hospice NPI, Start and End Dates and Revocation Code | C7010, U5235 |
Implantable Defibrillator | 7086A, 70865 | |
Incarcerated Beneficiary | U538H | |
Incorrect Discharge Status on History Claim | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status | 38114 |
Incorrect Patient Status due to Transfer to Another Facility | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status | C7111, C7272, E7272 |
Initial Preventive Physical Examination (IPPE) | Link to IPPE Booklet on the CMS website | U539I, U539J |
Initial Preventive Physical Examination (IPPE) EKG | Link to IPPE Booklet on the CMS website | U539K |
Inpatient Days Billing Error | 15202 | |
Inpatient Partial Benefits Exhaust | 39511 | |
Invalid HCPCS Code | W7006 | |
Invalid HCPCS/Revenue Code Combination | 32402 | |
Invalid HICN | U5061 | |
Invalid MBI | Link to MBI article on CMS website | 30993, U5060, U5062, U5065 |
Invalid Revenue Code or HIPPS Code | 37039 | |
IRF PAI Not On File/Incomplete/Mismatch | Link to MLN Matters Article | 37096 |
Late Filing with No Justification | 39011, 39012 | |
Local Coverage Determination (LCD) Denials | LCD policy number and link to CMS website to view the policy. | 51VIG, 52VIG, 53VIG, 54VIG, 55VIG, 56VIG, 57VIG, 58VIG, 5AVIG, 5BVIG, 5CVIG, 5DVIG, 5EVIG, 5FVIG, 5L002, 5L003, 5L010, 5L011, 5L012, 5L013, 5L014, 5L015, 5L016, 5L017, 5L018, 5L019, 5L022, 5L023, 5L026, 5L027, 5L030, 5L031, 5L032, 5L033, 5L037, 5L045, 5L046, 5L04A, 5L04B, 5L050, 5L051, 5L052, 5L053, 5L054, 5L055, 5L056, 5L057, 5L08A, 5L09A, 5L110, 5L111, 5L114, 5L131, 5L132, 5L133, 5L134, 5L135, 5L136, 5L139, 5L140, 5L143, 5L144, 5L145, 5L146, 5L147, 5L148, 5L149, 5L150, 5L151, 5L152, 5L153, 5L154, 5L155, 5L156, 5L157, 5L158, 5L159, 5L160, 5L163, 5L164, 5L173, 5L174, 5L177, 5L178, 5L179, 5L180, 5L181, 5L182, 5L183, 5L193, 5L194, 5L195, 5L196, 5L197, 5L198, 5L199, 5L200, 5L201, 5L202, 5L500, 5L501, 5L502, 5L503, 5L506, 5L507, 5L520, 5L521, 5L522, 5L523, 5L524, 5L526, 5L527, 5L530, 5L532, 5L533, 5L534, 5L535, 5L536, 5L539, 5L540, 5L541, 5L542, 5L545, 5L546, 5L547, 5L548, 5L549, 5L550, 5LA57, 5LA61, 5LA62, 5LA63, 5LA64, 5LA67, 5LA68, 5LA69, 5LA70, 5LA71, 5LA75, 5LA76, 5LA79, 5LA85, 5LA86, 5LA87, 5LA96, 5LA97, 5LA98, 5LA99, 5LB03, 5LB15, 5LB16, 5LB19, 5LB20, 5LB21, 5LB22, 5LB23, 5LB24, 5LB25, 5LB26, 5LB27, 5LB28, 5LB29, 5LB30, 5LB31, 5LB32, 5LB33, 5LB34, 5LB35, 5LB36, 5LB37, 5LB38, 5LB39, 5LB40, 5LB43, 5LB44, 5LB61, 5LB62, 5LB63, 5LB64, 5LB65, 5LB66, 5LB75, 5LB76, 5LB77, 5LB78, 5LB83, 5LB84, 5LB85, 5LB86, 5LB87, 5LB88, 5LB89, 5LB91, 5LB92, 5LB93, 5LB94, 5LB95, 5LB96, 5LB97, 5LB98, 5LC02, 5LC03, 5LC04, 5LC05, 5LC06, 5LC07, 5LC08, 5LC09, 5LC10, 5LC11, 5LC12, 5LC13, 5LC37, 5LC38, 5LC45, 5LC46, 5LC47, 5LC48, 5LC49, 5LC50, 5LC51, 5LC52, 5LC53, 5LC54, 5LC73, 5LC74, 5LC75, 5LC76, 5LC81, 5LC82, 5LC83, 5LC84, 5LC85, 5LC86, 5LD06, 5LD07, 5LD08, 5LD09, 5LD10, 5LD11, 5LD12, 5LD13, 5LD18, 5LD80, 5LD81, 5LD82, 5LD83, 5LD84, 5LD85, 5LD86, 5LD87, 5LD88, 5LE10, 5LE11, 5LE12, 5LE13, 5LE14, 5LE15, 5LE20, 5LE21, 5LE23, 5LE25, 5LE27, 5LE29, 5LE31, 5LE33, 5LE35, 5LE37, 5LE39, 5LE41, 5LE45, 5LE47, 5LE80, 5LE81, 5LE82, 5LE83, 5LE84, 5LE85, 5LE86, 5LE87, 5LE88, 5LE89, 5LE90, 5LE91, 5LE92, 5LE93, 5LF00, 5LF01, 5LF02, 5LF03, 5LF04, 5LF05, 5LF06, 5LF07, 5LF55, 5LF56, 5LF57, 5LF58, 5LF59, 5LF60, 5LF75, 5LF76, 5LF77, 5LF78, 5LFT2, 5LFT3, 5LN00, 5LNE0, 5LNE1, 5LPT0, 5LPT1, 5LPT4, 5LPT5, 5LPT6, 5LPT7, 5LPT8, 5LPT9, 5LPTA, 5LPTB, 5LPTC, 5LPTD, 5LPTE, 5LPTF, 5LPTI, 5LPTJ, 5LPTM, 5LPTN, 5LPTO, 5LPTP, 5LPTQ, 5LPTR, 5LT01, 5LT02, 5LT03, 5LT04, 5LT05, 5LT06, 5LT07, 5LT08, 5LT09, 5LT10, 5LT11, 5LT12, 5LT13, 5LT14, 5LT19, 5LT20, 5LT22, 5LT23, 5LT25, 5LT26, 5LT27, 5LT28, 5LT29, 5LT30, 5LT31, 5LT32, 5LT40, 5LT41, 5LT45, 5LT46, 5LT47, 5LT48, 5LT55, 5LT56, 5LT57, 5LT58, 5LT61, 5LT62, 5LT65, 5LT66, 5LT69, 5LT70, 5LT71, 5LT72, 5LT73, 5LT74, 5LT76, 5LT79, 5LT80, 5LT81, 5LT82, 5LT83, 5LT84, 5LT85, 5LT86, 5LT87, 5LT88, 5LT89, 5LT90, 5LT91, 5LT92, 5LT93, 5LT94, 5LT95, 5LT96, 5LV1G, 5LV2G, 5LV3G, 5LV4G, 5LVIG, 5LZ00, 5LZ01, 5LZ02, 5LZ03, 5LZ04, 5LZ05, 5LZ06, 5LZ07, 5LZ08, 5LZ09, 5LZ10, 5LZ11, 5LZ12, 5LZ13, 5LZ14, 5LZ15, 5LZ16, 5LZ17, 5LZ18, 5LZ19, 5LZ20, 5LZ21, 5LZ22, 5LZ23, 5LZ24, 5LZ25, 5LZ26, 5LZ27, 5LZ28, 5LZ29, 5LZ30, 5LZ31, 5LZ33, 5LZ34, 5LZ35, 5LZ36, 5LZ37, 5LZ38, 5LZ39, 5LZ40, 5LZ41, 5LZ42, 5LZ43, 5LZ44, 5LZ45, 5LZ46, 5LZ47, 5LZ48, 5LZ49, 5LZ50, 5LZ51, 5LZ52, 5LZ53, 5LZ54, 5LZ55, 5LZ56, 5LZ57, 5LZ58, 5LZ59, 5LZ60, 5LZ61, 5LZ62, 5LZ63, 5LZ64, 5LZ65, 5LZ66, 5LZ67, 5LZ68, 5LZ69, 5LZ70, 5LZ71, 5LZ72, 5LZ73, 5LZ74, 5LZ75, 5LZ76, 5LZ77, 5LZ78, 5LZ79, 5LZ80, 5LZ81, 5LZ82, 5LZ83, 5LZ84, 5LZ85, 5LZ86, 5LZ87, 5LZ88, 5LZ89, 5LZ90, 5LZ93, 5LZ94, 5LZ95, 5LZ96, 5LZ97, 5LZ98, 5LZA1, 5LZA2, 5LZA5, 5LZA6, 5LZAA, 5LZAB, 5LZAC, 5LZAD, 5LZAE, 5LZAF, 5LZAI, 5LZAJ, 5LZAK, 5LZAL, 5LZAM, 5LZAN, 5LZAQ, 5LZAR, 5LZAW, 5LZAX, 5LZAY, 5LZAZ, 5LZB0, 5LZB1, 5LZB2, 5LZB3, 5LZB4, 5LZB5, 5LZB6, 5LZB7, 5LZB8, 5LZB9, 5LZBA, 5LZBB, 5LZBC, 5LZBD, 5LZBE, 5LZBF, 5LZBG, 5LZBH, 5LZBM, 5LZBN, 5LZBO, 5LZBP, 5LZBQ, 5LZBT, 5LZBU, 5LZBV, 5LZBW, 5LZBX, 5LZBY, 5LZBZ, 5LZCA, 5LZCB, 5lZCD, 5LZCE, 5LZCF, 5LZCG, 5LZCH, 5LZCI, 5LZCJ, 5LZCK, 5LZCL, 5LZCL, 5LZCM, 5LZCN, 5LZCO, 5LZCP, 5LZCQ, 5LZCR, 5LZCS, 5LZCT, 5LZCU, 5LZCV, 5LZCW, 5LZCX, 5LZCY, 5LZDA, 5LZDB, 5LZDC, 5LZDD, 5LZDE, 5LZDF, 5LZDG, 5LZDH, 5LZDI, 5LZDJ, 5LZDK, 5LZDL, 5LZDM, 5LZDN, 5LZDO, 5LZDP, 5LZDQ, 5LZDR, 5LZDS, 5LZDT, 5LZDV, 5LZDW, 5LZDX, 5LZDY, 5LZDZ, 5LZEA, 5LZEB, 5LZEC, 5LZED, 5LZEE, 5LZEF, 5LZEG, 5LZEH, 5LZEI, 5LZEJ, 5LZEK, 5LZEL, 5LZEM, 5LZEN, 5LZEO, 5LZEP, 5LZEW, 5LZEX, 5LZEY, 5LZEZ, 5MVIG, 5NVIG, 5OVIG, 5PCBB, 5PCBM, 5PCCR, 5PCFT, 5PCIN, 5PCMM, 5PCST, 5PCWC, 7PAC1, 7PAC2, 7PAC3, 7PAC4, 51VIG, 52VIG, 53CDA, 53VIG, 54VIG, 55VIG, 56VIG, 57VIG, 58VIG, 5AVIG, 5BCBB, 5BCCR, 5BCFT, 5BCIN, 5BCMM, 5BCST, 5BCWC, 5BLBB, 5BLCR, 5BLFT, 5BLIN, 5BLMM, 5BLST, 5BLWC, 5BVIG, 5CVIG, 5DVIG, 5EVIG, 5FVIG, 5GVIG, 5HVIG, 5IVIG, 5JVIG, 5KVIG, 5L001, 5L002, 5L003, 5L006, 5L007, 5L008, 5L009, 5L010, 5L011, 5L012, 5L013, 5L014, 5L015, 5L016, 5L017, 5L018, 5L019, 5L022, 5L023, 5L024, 5L025, 5L026, 5L027, 5L030, 5L031, 5L032, 5L033, 5L041, 5L042, 5L045, 5L046, 5L049, 5L04A, 5L04B, 5L050, 5L051, 5L052, 5L053, 5L054, 5L055, 5L056, 5L057, 5L063, 5L064, 5L065, 5L066, 5L080, 5L081, 5L084, 5L085, 5L086, 5L087, 5L08A, 5L08B, 5L09A, 5L09B, 5L106, 5L107, 5L108, 5L109, 5L110, 5L111, 5L114, 5L131, 5L132, 5L133, 5L134, 5L135, 5L136, 5L139, 5L140, 5L143, 5L144, 5L145, 5L146, 5L147, 5L148, 5L149, 5L150, 5L151, 5L152, 5L153, 5L154, 5L159, 5L160, 5L163, 5L164, 5L173, 5L174, 5L177, 5L178, 5L179, 5L180, 5L181, 5L182, 5L183, 5L193, 5L194, 5L195, 5L196, 5L197, 5L198, 5L199, 5L200, 5L201, 5L202, 5L500, 5L501, 5L502, 5L503, 5L504, 5L505, 5L506, 5L507, 5L520, 5L521, 5L522, 5L523, 5L524, 5L525, 5L526, 5L527, 5L530, 5L532, 5L533, 5L534, 5L535, 5L536, 5L537, 5L538, 5L539, 5L540, 5L541, 5L542, 5L543, 5L544, 5L545, 5L546, 5L547, 5L548, 5L549, 5L550, 5L551, 5L552, 5LA55, 5LA56, 5LA57, 5LA58, 5LA59, 5LA60, 5LA61, 5LA62, 5LA63, 5LA64, 5LA65, 5LA66, 5LA67, 5LA68, 5LA69, 5LA70, 5LA71, 5LA72, 5LA73, 5LA74, 5LA75, 5LA76, 5LA79, 5LA80, 5LA82, 5LA83, 5LA85, 5LA86, 5LA87, 5LA90, 5LA96, 5LA99, 5LB00, 5LB01, 5LB02, 5LB03, 5LB05, 5LB06, 5LB07, 5LB08, 5LB09, 5LB10, 5LB11, 5LB12, 5LB13, 5LB14, 5LB15, 5LB16, 5LB19, 5LB20, 5LB21, 5LB22, 5LB23, 5LB24, 5LB25, 5LB26, 5LB27, 5LB28, 5LB29, 5LB30, 5LB31, 5LB32, 5LB33, 5LB34, 5LB35, 5LB36, 5LB37, 5LB38, 5LB39, 5LB40, 5LB61, 5LB62, 5LB63, 5LB64, 5LB65, 5LB66, 5LB67, 5LB71, 5LB72, 5LB73, 5LB74, 5LB75, 5LB76, 5LB77, 5LB78, 5LB79, 5LB80, 5LB81, 5LB82, 5LB83, 5LB84, 5LB85, 5LB86, 5LB87, 5LB88, 5LB89, 5LB90, 5LB91, 5LB92, 5LB93, 5LB94, 5LB95, 5LB96, 5LB97, 5LB98, 5LC01, 5LC02, 5LC03, 5LC04, 5LC05, 5LC06, 5LC07, 5LC08, 5LC09, 5LC10, 5LC11, 5LC12, 5LC13, 5LC45, 5LC46, 5LC47, 5LC48, 5LC49, 5LC50, 5LC51, 5LC52, 5LC53, 5LC54, 5LC55, 5LC56, 5LC57, 5LC58, 5LC59, 5LC60, 5LC63, 5LC64, 5LC73, 5LC74, 5LC75, 5LC76, 5LC81, 5LC82, 5LC83, 5LC84, 5LC85, 5LC86, 5LD00, 5LD01, 5LD02, 5LD06, 5LD07, 5LD08, 5LD09, 5LD10, 5LD11, 5LD12, 5LD13, 5LD14, 5LD15, 5LD16, 5LD17, 5LD18, 5LD55, 5LD56, 5LD57, 5LD58, 5LD59, 5LD61, 5LD62, 5LD63, 5LD64, 5LD65, 5LD66, 5LD80, 5LD81, 5LD82, 5LD83, 5LD84, 5LD85, 5LD86, 5LE10, 5LE11, 5LE12, 5LE13, 5LE14, 5LE15, 5LE20, 5LE21, 5LE22, 5LE23, 5LE24, 5LE25, 5LE26, 5LE27, 5LE28, 5LE29, 5LE30, 5LE31, 5LE32, 5LE33, 5LE34, 5LE35, 5LE36, 5LE37, 5LE38, 5LE39, 5LE40, 5LE41, 5LE42, 5LE44, 5LE45, 5LE46, 5LE47, 5LE80, 5LE81, 5LE82, 5LE83, 5LE84, 5LE85, 5LE86, 5LE87, 5LE88, 5LE89, 5LE90, 5LE91, 5LE92, 5LE93, 5LF00, 5LF01, 5LF02, 5LF03, 5LF04, 5LF05, 5LF06, 5LF07, 5LF55, 5LF56, 5LF57, 5LF58, 5LF59, 5LF60, 5LF75, 5LF76, 5LF77, 5LF78, 5LFT2, 5LFT3, 5LN00, 5LN01, 5LNE0, 5LNE1, 5LPT0, 5LPT1, 5LPT4, 5LPT5, 5LPT6, 5LPT7, 5LPT8, 5LPT9, 5LPTA, 5LPTB, 5LPTC, 5LPTD, 5LPTE, 5LPTF, 5LPTI, 5LPTJ, 5LPTM, 5LPTN, 5LPTO, 5LPTP, 5LPTQ, 5LPTR, 5LPTT, 5LPTU, 5LT01, 5LT02, 5LT03, 5LT04, 5LT05, 5LT06, 5LT07, 5LT08, 5LT09, 5LT10, 5LT11, 5LT12, 5LT13, 5LT14, 5LT17, 5LT18, 5LT19, 5LT20, 5LT22, 5LT23, 5LT25, 5LT26, 5LT27, 5LT28, 5LT29, 5LT30, 5LT31, 5LT32, 5LT40, 5LT41, 5LT45, 5LT46, 5LT47, 5LT48, 5LT52, 5LT53, 5LT55, 5LT56, 5LT57, 5LT58, 5LT61, 5LT62, 5LT63, 5LT64, 5LT65, 5LT66, 5LT67, 5LT68, 5LT69, 5LT70, 5LT71, 5LT72, 5LT73, 5LT74, 5LT75, 5LT76, 5LT79, 5LT80, 5LT81, 5LT82, 5LT83, 5LT84, 5LT85, 5LT86, 5LT87, 5LT88, 5LT89, 5LT90, 5LT91, 5LT92, 5LT93, 5LT94, 5LT95, 5LT96, 5LV1G, 5LV2G, 5LV3G, 5LV4G, 5LVIG, 5LZ02, 5LZ03, 5LZ04, 5LZ05, 5LZ06, 5LZ07, 5LZ08, 5LZ09, 5LZ12, 5LZ13, 5LZ14, 5LZ15, 5LZ16, 5LZ17, 5LZ18, 5LZ19, 5LZ20, 5LZ21, 5LZ22, 5LZ23, 5LZ24, 5LZ25, 5LZ26, 5LZ27, 5LZ28, 5LZ29, 5LZ30, 5LZ31, 5LZ34, 5LZ35, 5LZ36, 5LZ37, 5LZ38, 5LZ39, 5LZ40, 5LZ41, 5LZ42, 5LZ43, 5LZ44, 5LZ45, 5LZ46, 5LZ47, 5LZ48, 5LZ49, 5LZ50, 5LZ51, 5LZ52, 5LZ53, 5LZ54, 5LZ55, 5LZ56, 5LZ57, 5LZ58, 5LZ59, 5LZ60, 5LZ61, 5LZ62, 5LZ63, 5LZ64, 5LZ65, 5LZ66, 5LZ67, 5LZ68, 5LZ69, 5LZ70, 5LZ71, 5LZ72, 5LZ73, 5LZ74, 5LZ75, 5LZ76, 5LZ77, 5LZ78, 5LZ79, 5LZ80, 5LZ81, 5LZ82, 5LZ83, 5LZ84, 5LZ85, 5LZ86, 5LZ87, 5LZ88, 5LZ89, 5LZ93, 5LZ94, 5LZ95, 5LZ96, 5LZ97, 5LZ98, 5LZA1, 5LZA2, 5LZA5, 5LZA6, 5LZAC, 5LZAD, 5LZAE, 5LZAF, 5LZAG, 5LZAH, 5LZAI, 5LZAJ, 5LZAK, 5LZAL, 5LZAM, 5LZAN, 5LZAQ, 5LZAR, 5LZAW, 5LZAX, 5LZAY, 5LZAZ, 5LZB0, 5LZB1, 5LZB2, 5LZB3, 5LZB4, 5LZB5, 5LZB6, 5LZB7, 5LZB8, 5LZB9, 5LZBA, 5LZBB, 5LZBC, 5LZBD, 5LZBE, 5LZBF, 5LZBG, 5LZBH, 5LZBM, 5LZBN, 5LZBO, 5LZBP, 5LZBQ, 5LZBT, 5LZBU, 5LZBV, 5LZBW, 5LZBX, 5LZBY, 5LZBZ, 5LZCA, 5LZCB, 5LZCC, 5LZCD, 5LZCE, 5LZCF, 5LZCG, 5LZCH, 5LZCI, 5LZCJ, 5LZCK, 5LZCL, 5LZCM, 5LZCN, 5LZCO, 5LZCP, 5LZCQ, 5LZCR, 5LZCS, 5LZCT, 5LZCU, 5LZCV, 5LZCW, 5LZCX, 5LZCY, 5LZDA, 5LZDB, 5LZDC, 5LZDD, 5LZDE, 5LZDF, 5LZDG, 5LZDH, 5LZDI, 5LZDJ, 5LZDK, 5LZDL, 5LZDM, 5LZDN, 5LZDO, 5LZDP, 5LZDQ, 5LZDR, 5LZDS, 5LZDT, 5LZDU, 5LZDV, 5LZDW, 5LZDX, 5LZDY, 5LZDZ, 5LZEA, 5LZEB, 5LZEC, 5LZED, 5LZEE, 5LZEF, 5LZEG, 5LZEH, 5LZEI, 5LZEJ, 5LZEK, 5LZEL, 5LZEM, 5LZEN, 5LZEO, 5LZEP, 5LZEQ, 5LZER, 5LZES, 5LZET, 5LZEU, 5LZEV, 5LZEW, 5LZEX, 5LZEY, 5LZEZ, 5LZFA, 5LZFB, 5LZFC, 5LZFD, 5LZFE, 5LZFF, 5LZFG, 5LZFH, 5LZFI, 5LZFJ, 5MVIG, 5NVIG, 5OVIG, 5PCBB, 5PCCR, 5PCFT, 5PCIN, 5PCMM, 5PCST, 5PCWC, 5PLBB, 5PLBM, 5PLCR, 5PLFT, 5PLIN, 5PLMM, 5PLST, 5PLWC, 7JET3, 7PAC1, 7PAC2, 7PAC3, 7PAC4, 7RI28, 7RI29, 7RI36, 7RI37, 7RI38, 7RI39, 7RI41, 7RI42, 7RI43 |
Mammography Certification | 36428 | |
Managed Care Organization (MCO) or Health Maintenance Organization (HMO) Denials | MCO/HMO Name, Address, Plan Number, and Plan Type | 39001, U5233 |
Medicare Secondary Payer (MSP) Auto/No Fault | Insurer Name and Address, Effective and Term Date, MSP Type | 31308, 34009, 34010, 34011, 34087, 34088, 34089, 34090, 34133, 34138, 34139, 34140, 34141, 34142, 34271, 34277, 34287, 34299, 34311, 34365, 34372, 34383, 34384, 34507, 34551, 34544 |
Medicare Secondary Payer (MSP) Black Lung | Insurer Name and Address, Effective and Term Date, MSP Type | 34019, 34020, 34119, 34120, 34121, 34122, 34135, 34274, 34279, 34290, 34302, 34314, 34368, 34375, 34399, 34509, 34400, 34548, 37189 |
Medicare Secondary Payer (MSP) Conditional Payment | Insurer Name and Address, Effective and Term Date, MSP Type | 31406 |
Medicare Secondary Payer (MSP) Disability | Insurer Name and Address, Effective and Term Date, MSP Type | 34022 34023 34057 34099 34100 34101 34102 34115 34116 34117 34118 34129 34132 34157 34164 34257 34264 34267 34283 34286 34295 34298 34307 34310 34357 34371 34389 34390 34397 34398 34503 34515 34521 34530 34531 34536 34537 34540 34064 34506 34518 34524 34543 U680G |
Medicare Secondary Payer (MSP) ESRD/EGHP | Insurer Name and Address, Effective and Term Date, MSP Type | 34006, 34007, 34008, 34051, 34095, 34096, 34097, 34098, 34107, 34108, 34109, 34110, 34128, 34131, 34151, 34163, 34251, 34263, 34266, 34269, 34282, 34285, 34294, 34297, 34306, 34309, 34351, 34363, 34387, 34388, 34393, 34394, 34502, 34505, 34515, 34517, 34520, 34523, 34528, 34529, 34534, 34535, 34539, 34542 |
Medicare Secondary Payer (MSP) Information Incorrect | 77777 | |
Medicare Secondary Payer (MSP) Liability | Insurer Name and Address, Effective and Term Date, MSP Type | 34036, 34037, 34083, 34084, 34085, 34086, 34137, 34148, 34149, 34152, 34153, 34154, 34276, 34280, 34292, 34304, 34316, 34370, 34377, 34381, 34382, 34512, 34549, 34550, 37209, 39073 |
Medicare Secondary Payer (MSP) Missing or Invalid Payer Code | Insurer Name and Address, Effective and Term Date, MSP Type | 31300 |
Medicare Secondary Payer (MSP) Missing Value Code | Insurer Name and Address, Effective and Term Date, MSP Type | 31306 |
Medicare Secondary Payer (MSP) Value Code 44 Error | Insurer Name and Address, Effective and Term Date, MSP Type | 33981 |
Medicare Secondary Payer (MSP) Value Code Incorrect | 77775 | |
Medicare Secondary Payer (MSP) Workers’ Compensation | Insurer Name and Address, Effective and Term Date, MSP Type | 34012, 34013, 34014, 34079, 34080, 34081, 34082, 34134, 34143, 34144, 34145, 34146, 34147, 34272, 34278, 34288, 34300, 34312, 34366, 34373, 34378, 34379, 34380, 34508, 34525, 34545 |
Medicare Secondary Payer (MSP) Working Aged Denials | Insurer Name and Address, Effective and Term Date, MSP Type | 34002, 34003, 34004, 34050, 34060, 34070, 34062, 34066, 34091, 34092, 34093, 34094, 34103, 34104, 34105, 34106, 34127, 34130, 34150, 34162, 34250, 34262, 34265, 34268, 34270, 34281, 34284, 34293, 34296, 34305, 34308, 34350, 34362, 34364, 34385, 34386, 34391, 34392, 34450, 34462, 34465, 34468, 34471, 34474, 34477, 34480, 34483, 34486, 34489, 34492, 34495, 34498, 34501, 34504, 34513, 34516, 34519, 34522, 34526, 34527, 34532, 34533, 34538, 34541, U6803 |
Medicare Secondary Payer (MSP) Value Code submitted, Medicare is Primary | Insurer Name and Address, Effective and Term Date, MSP Type | 77745 |
Medically Unlikely Edit (MUE) Denials | Link to the Facility Outpatient Services MUE table located on the CMS website | 52MUE, 51MUE, 53MUE, 55MUE, 57MUE, 59MUE, 5BMUE, 5DMUE, 54MUE, 56MUE, 58MUE, 5AMUE, 5CMUE, 5EMUE |
Missing or Insufficient Documentation | 56900, 5PC01 5PC02 5PC03 5PC04 5PC12 5PC13 5PC14 5PC15 5PC16 5PC17 5PC18 | |
Missing or Invalid HCPCS | 32400, 32401, 32403, 32404 | |
Missing or Invalid MolDx Identifier | 5LZ00, 7LZ00, 7LZ02, 7LZ01, 7LZ03 | |
Multiple Observation Overlap | W7051 | |
National Correct Coding Initiative (NCCI) | Links to NCCI information and code pairs on CMS website | W7020, W7040, 55438, 55439 |
National Coverage Determination (NCD) Denials | NCD policy number and link to CMS website to view the policy. | 31763, 50129, 59001, 59002, 59004, 59006, 59008, 59011, 59012, 59013, 59014, 59015, 59016, 59017, 59018, 59019, 59020, 59021, 59022, 59023, 59024, 59025, 59026, 59027, 59028, 59029, 59030, 59031, 59032, 59033, 59034, 59035, 59036, 59037, 59038, 59039, 59040, 59041, 59042, 59043, 59044, 59045, 59046, 59047, 59048, 59049, 59050, 59051, 59052, 59053, 59054, 59055, 59056, 59057, 59058, 59059, 59060, 59061, 59062, 59063, 59064, 59065, 59066, 59067, 59068, 59069, 59070, 59071, 59072, 59073, 59074, 59075, 59076, 59079, 59080, 59081, 59082, 59083, 59084, 59085, 59086, 59087, 59088, 59089, 59090, 59091, 59092, 59093, 59094, 59095, 59096, 59097, 59098, 59099, 59100, 59101, 59102, 59103, 59104, 59105, 59106, 59107, 59108, 59109, 59110, 59112, 59113, 59114, 59115, 59116, 59117, 59118, 59119, 59120, 59121, 59122, 59123, 59124, 59125, 59126, 59127, 59128, 59129, 59130, 59131, 59132, 59133, 59134, 59135, 59136, 59137, 59138, 59139, 59140, 59141, 59142, 59143, 59144, 59145, 59146, 59147, 59148, 59149, 59150, 59151, 59152, 59153, 59154, 59155, 59156, 59157, 59158, 59159, 59161, 59162, 59163, 59164, 59165, 59166, 59167, 59170, 59171, 59172, 59173, 59174, 59175, 59176, 59177, 59180, 59181, 59182, 59183, 59186, 59187, 59190, 59191, 59192, 59193, 59194, 59195, 59196, 59197, 59198, 59199, 59201, 59202, 59203, 59204, 59205, 59206, 59207, 59208, 59209, 59210, 59211, 59212, 59234, 59235, 59236, 59237, 59238, 59239, 59240, 59241, 59242, 59243, 59244, 59245, 59246, 59247, 59248, 59249, 59266, 59271, 59272, 59273, 59274, 59275, 59276, 59277, 59278, 59279, 59280, 59281, 59282, 59283, 59284, 59285, 59286, 59287, 59288, 59289, 59290, 59291, 59292, 59293, 59294, 59295, 59296, 59297, 59298, 59299, 59300, 59301, 59302, 59303, 59304, 59305, 59306, 59311, 59312, 71755, 75013, 75294, 75727, 59C04, 59C05, 59C06, 59C07, 59C08, 59C09, 59C10, 59C13, 59C14, 59C15, 59C16, 59C17, 59C18, 59C19, 59C20, 59C21, 59C22, 59C23, 59C24, 59C25, 59C26, 59C27, 59C28, 59C29, 59C30, 59C31, 59C32, 59C33, 59C34, 59C40, 59C41, 59C42, 59C43, 59C48, 59C49, 5L189, 5L190, 5L191, 5L192, 5LD04, 5LN02, 5LN03, 5LN28, 5LN29, 5LN30, 5LN31, 5LN32, 5LN33, 5LN34, 5LN35, 5LN36, 5LN37, 5LN38, 5LZ91, 5LZ92, 5ND28, 5ND29, 5PEF1, 5PEF2, 7501A, 7501D, 7501E, 7501F, 7501G, 7501H, 7501I, 7501J, 7501K, 7572A, U523B, U523C, U5306, U5327, U5328, U5329, U5331, U537L, U537M, U5612, U5616 |
No Response to ADR | 39721 | |
OIG Audit | 7OIG2, 7OIG3, 7OIG5, 7OIG6 | |
Original Claim was Medically Reviewed | 30940 | |
Overlapping Claim Dates | Displays INPA information: NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient indicator | C7070 |
Outpatient Diagnostic Service within 72 Hours of an Inpatient Claim | C7113 | |
Part A Days Applied Incorrectly | 12206 | |
Patient Not Lawfully in the US | U538Q | |
PET Scan with no Valid Cancer Diagnosis | Link to the Medicare Coverage Database on the CMS website. | 7ICD7, 7ICD8, 7ICD9 |
Prostate Cancer Screening Test Frequency | Link to the Medicare Coverage Database and the Preventive Services tool on the CMS website. Eligibility link to Preventive Services. | U5383 |
Returned to Provider for Correction | 38305 | |
Service is After Beneficiary Date of Death | U5211, U5212 | |
Service not Billable under OPPS OCE | Links to Addendums on CMS Website | W7072 |
Skilled Nursing Facility (SNF) Claim does not meet Qualifying Stay | 13313, C7123 | |
Skilled Nursing Facility (SNF) Claim Sequence Error | 38119 | |
SNF Overlap Denials (Displays overlapping dates and any prior SNF claims) | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | C7251 |
Supplemental Medical Review Contractor (SMRC) | 7SMR0, 7SMR1, 7SMR2, 7SMR3, 7SMR4, 7SMR5, 7SMR6, 7SMR7, 7SMR8, 7SMR9 | |
Swing-Bed Billing Error | C7127 | |
Therapy Limit Exceeded | Displays Patient Therapy Cap Used | 7V822, 7V824 |
Veterans Administration (VA) Coverage | 34123, 34124, 34125, 34126, 34376, 34511, 34547, 34401, 34402, 37198 |
If you would like to suggest a denial category or denial reason code for the enhanced denial information, please let us know! Suggestions can be emailed to medicareadmin@wpsic.com. We update the denials often and would like to provide information that will help you be more efficient.
Part A Claim Category | Additional Information available in More Info | Part A Reason Codes |
---|---|---|
Add-on Code without Primary Procedure Code | Link to Add-on Code Edits page on CMS website | W7106, W7107, W7108, W7084 |
Adjustment of a Previously Adjusted Claim | 30912 | |
Adjustment with no Original Claim on File | 30902, 30905, 30906 | |
Adjustment Submitted with Condition Code D9 with No Remarks | 37541 | |
Admit Date Prior to From Date | U5606 | |
Annual Wellness Visit (AWV) | Link to AWV booklet on CMS website | U5273, U5274, U5275, U5276, U5310 |
Beneficiary Eligibility | U5200, U5210, U5220 | |
Benefits Exhausted | 39510 | |
Benefits Exhaust SNF | 39508 | |
Condition Codes MO-MZ Changed by Submitter |
30008 | |
Cost Report Days and Accommodation Units Mismatch | 37025 | |
Date of Service Overlap Denials - Inpatient | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status | C7252, C7080, C7050, C7279, C729C, 75601, 38002, 38017, 38018, 38019, 38020, 38022, 38086, 38108, 38112, 38115, U5601, U7080 |
Date of Service Overlap Denials - Outpatient | Outpatient Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 38024 |
Diagnosis May Be No Fault, Workers Comp or Liability | Insurer Name and Address, Effective and Term Date, MSP Type | 39074 |
Documentation Not Received Timely | 39721 | |
Duplicate Denials - Inpatient | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 38001, 38004, 38005, 38007, 38013, 38023 |
Duplicate Denials - Outpatient | Outpatient Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 30919, 38025, 38026, 38031, 38032, 38034, 38035, 38037, 38038, 38052, 38054, 38061, 38067, 38070, 38072, 38076, 38077, 38092, 38097, 38105, 38109, 38111, 38113, 38130, 38135, 38136, 38137, 38138, 38139, 38149, 38151, 38152, 38153, 38154, 38155, 38159, 38200, 38308, 38312, C7055, C7112, C7253, C7254, C7255 |
Duplicate 3D Conformal Radiation Therapy Planning Services | C7715 | |
ESRD Consolidated Billing | Outpatient Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | 10422, C7565, 10423, C7566, C729A |
HICN Submitted after 01/01/2020 | 30995 | |
Home Health Denials | Home Health NPI, Patient Status, Start and End Date, Earliest and Latest Billing Action Dates | U5390 |
Hospice Enrollment Denials | Hospice NPI, Start and End Dates and Revocation Code | C7010, U5235 |
Implantable Defibrillator | 7086A, 70865 | |
Incarcerated Beneficiary | U538H | |
Incorrect Discharge Status on History Claim | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status | 38114 |
Incorrect Patient Status due to Transfer to Another Facility | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status | C7111, C7272, E7272 |
Initial Preventive Physical Examination (IPPE) | Link to IPPE Booklet on the CMS website | U539I, U539J |
Initial Preventive Physical Examination (IPPE) EKG | Link to IPPE Booklet on the CMS website | U539K |
Inpatient Days Billing Error | 15202 | |
Inpatient Partial Benefits Exhaust | 39511 | |
Invalid HCPCS Code | W7006 | |
Invalid HCPCS/Revenue Code Combination | 32402 | |
Invalid HICN | U5061 | |
Invalid MBI | Link to MBI article on CMS website | 30993, U5060, U5062, U5065 |
Invalid Revenue Code or HIPPS Code | 37039 | |
IRF PAI Not On File/Incomplete/Mismatch | Link to MLN Matters Article | 37096 |
Late Filing with No Justification | 39011, 39012 | |
Local Coverage Determination (LCD) Denials | LCD policy number and link to CMS website to view the policy. | 51VIG, 52VIG, 53VIG, 54VIG, 55VIG, 56VIG, 57VIG, 58VIG, 5AVIG, 5BVIG, 5CVIG, 5DVIG, 5EVIG, 5FVIG, 5L002, 5L003, 5L010, 5L011, 5L012, 5L013, 5L014, 5L015, 5L016, 5L017, 5L018, 5L019, 5L022, 5L023, 5L026, 5L027, 5L030, 5L031, 5L032, 5L033, 5L037, 5L045, 5L046, 5L04A, 5L04B, 5L050, 5L051, 5L052, 5L053, 5L054, 5L055, 5L056, 5L057, 5L08A, 5L09A, 5L110, 5L111, 5L114, 5L131, 5L132, 5L133, 5L134, 5L135, 5L136, 5L139, 5L140, 5L143, 5L144, 5L145, 5L146, 5L147, 5L148, 5L149, 5L150, 5L151, 5L152, 5L153, 5L154, 5L155, 5L156, 5L157, 5L158, 5L159, 5L160, 5L163, 5L164, 5L173, 5L174, 5L177, 5L178, 5L179, 5L180, 5L181, 5L182, 5L183, 5L193, 5L194, 5L195, 5L196, 5L197, 5L198, 5L199, 5L200, 5L201, 5L202, 5L500, 5L501, 5L502, 5L503, 5L506, 5L507, 5L520, 5L521, 5L522, 5L523, 5L524, 5L526, 5L527, 5L530, 5L532, 5L533, 5L534, 5L535, 5L536, 5L539, 5L540, 5L541, 5L542, 5L545, 5L546, 5L547, 5L548, 5L549, 5L550, 5LA57, 5LA61, 5LA62, 5LA63, 5LA64, 5LA67, 5LA68, 5LA69, 5LA70, 5LA71, 5LA75, 5LA76, 5LA79, 5LA85, 5LA86, 5LA87, 5LA96, 5LA97, 5LA98, 5LA99, 5LB03, 5LB15, 5LB16, 5LB19, 5LB20, 5LB21, 5LB22, 5LB23, 5LB24, 5LB25, 5LB26, 5LB27, 5LB28, 5LB29, 5LB30, 5LB31, 5LB32, 5LB33, 5LB34, 5LB35, 5LB36, 5LB37, 5LB38, 5LB39, 5LB40, 5LB43, 5LB44, 5LB61, 5LB62, 5LB63, 5LB64, 5LB65, 5LB66, 5LB75, 5LB76, 5LB77, 5LB78, 5LB83, 5LB84, 5LB85, 5LB86, 5LB87, 5LB88, 5LB89, 5LB91, 5LB92, 5LB93, 5LB94, 5LB95, 5LB96, 5LB97, 5LB98, 5LC02, 5LC03, 5LC04, 5LC05, 5LC06, 5LC07, 5LC08, 5LC09, 5LC10, 5LC11, 5LC12, 5LC13, 5LC37, 5LC38, 5LC45, 5LC46, 5LC47, 5LC48, 5LC49, 5LC50, 5LC51, 5LC52, 5LC53, 5LC54, 5LC73, 5LC74, 5LC75, 5LC76, 5LC81, 5LC82, 5LC83, 5LC84, 5LC85, 5LC86, 5LD06, 5LD07, 5LD08, 5LD09, 5LD10, 5LD11, 5LD12, 5LD13, 5LD18, 5LD80, 5LD81, 5LD82, 5LD83, 5LD84, 5LD85, 5LD86, 5LD87, 5LD88, 5LE10, 5LE11, 5LE12, 5LE13, 5LE14, 5LE15, 5LE20, 5LE21, 5LE23, 5LE25, 5LE27, 5LE29, 5LE31, 5LE33, 5LE35, 5LE37, 5LE39, 5LE41, 5LE45, 5LE47, 5LE80, 5LE81, 5LE82, 5LE83, 5LE84, 5LE85, 5LE86, 5LE87, 5LE88, 5LE89, 5LE90, 5LE91, 5LE92, 5LE93, 5LF00, 5LF01, 5LF02, 5LF03, 5LF04, 5LF05, 5LF06, 5LF07, 5LF55, 5LF56, 5LF57, 5LF58, 5LF59, 5LF60, 5LF75, 5LF76, 5LF77, 5LF78, 5LFT2, 5LFT3, 5LN00, 5LNE0, 5LNE1, 5LPT0, 5LPT1, 5LPT4, 5LPT5, 5LPT6, 5LPT7, 5LPT8, 5LPT9, 5LPTA, 5LPTB, 5LPTC, 5LPTD, 5LPTE, 5LPTF, 5LPTI, 5LPTJ, 5LPTM, 5LPTN, 5LPTO, 5LPTP, 5LPTQ, 5LPTR, 5LT01, 5LT02, 5LT03, 5LT04, 5LT05, 5LT06, 5LT07, 5LT08, 5LT09, 5LT10, 5LT11, 5LT12, 5LT13, 5LT14, 5LT19, 5LT20, 5LT22, 5LT23, 5LT25, 5LT26, 5LT27, 5LT28, 5LT29, 5LT30, 5LT31, 5LT32, 5LT40, 5LT41, 5LT45, 5LT46, 5LT47, 5LT48, 5LT55, 5LT56, 5LT57, 5LT58, 5LT61, 5LT62, 5LT65, 5LT66, 5LT69, 5LT70, 5LT71, 5LT72, 5LT73, 5LT74, 5LT76, 5LT79, 5LT80, 5LT81, 5LT82, 5LT83, 5LT84, 5LT85, 5LT86, 5LT87, 5LT88, 5LT89, 5LT90, 5LT91, 5LT92, 5LT93, 5LT94, 5LT95, 5LT96, 5LV1G, 5LV2G, 5LV3G, 5LV4G, 5LVIG, 5LZ00, 5LZ01, 5LZ02, 5LZ03, 5LZ04, 5LZ05, 5LZ06, 5LZ07, 5LZ08, 5LZ09, 5LZ10, 5LZ11, 5LZ12, 5LZ13, 5LZ14, 5LZ15, 5LZ16, 5LZ17, 5LZ18, 5LZ19, 5LZ20, 5LZ21, 5LZ22, 5LZ23, 5LZ24, 5LZ25, 5LZ26, 5LZ27, 5LZ28, 5LZ29, 5LZ30, 5LZ31, 5LZ33, 5LZ34, 5LZ35, 5LZ36, 5LZ37, 5LZ38, 5LZ39, 5LZ40, 5LZ41, 5LZ42, 5LZ43, 5LZ44, 5LZ45, 5LZ46, 5LZ47, 5LZ48, 5LZ49, 5LZ50, 5LZ51, 5LZ52, 5LZ53, 5LZ54, 5LZ55, 5LZ56, 5LZ57, 5LZ58, 5LZ59, 5LZ60, 5LZ61, 5LZ62, 5LZ63, 5LZ64, 5LZ65, 5LZ66, 5LZ67, 5LZ68, 5LZ69, 5LZ70, 5LZ71, 5LZ72, 5LZ73, 5LZ74, 5LZ75, 5LZ76, 5LZ77, 5LZ78, 5LZ79, 5LZ80, 5LZ81, 5LZ82, 5LZ83, 5LZ84, 5LZ85, 5LZ86, 5LZ87, 5LZ88, 5LZ89, 5LZ90, 5LZ93, 5LZ94, 5LZ95, 5LZ96, 5LZ97, 5LZ98, 5LZA1, 5LZA2, 5LZA5, 5LZA6, 5LZAA, 5LZAB, 5LZAC, 5LZAD, 5LZAE, 5LZAF, 5LZAI, 5LZAJ, 5LZAK, 5LZAL, 5LZAM, 5LZAN, 5LZAQ, 5LZAR, 5LZAW, 5LZAX, 5LZAY, 5LZAZ, 5LZB0, 5LZB1, 5LZB2, 5LZB3, 5LZB4, 5LZB5, 5LZB6, 5LZB7, 5LZB8, 5LZB9, 5LZBA, 5LZBB, 5LZBC, 5LZBD, 5LZBE, 5LZBF, 5LZBG, 5LZBH, 5LZBM, 5LZBN, 5LZBO, 5LZBP, 5LZBQ, 5LZBT, 5LZBU, 5LZBV, 5LZBW, 5LZBX, 5LZBY, 5LZBZ, 5LZCA, 5LZCB, 5lZCD, 5LZCE, 5LZCF, 5LZCG, 5LZCH, 5LZCI, 5LZCJ, 5LZCK, 5LZCL, 5LZCL, 5LZCM, 5LZCN, 5LZCO, 5LZCP, 5LZCQ, 5LZCR, 5LZCS, 5LZCT, 5LZCU, 5LZCV, 5LZCW, 5LZCX, 5LZCY, 5LZDA, 5LZDB, 5LZDC, 5LZDD, 5LZDE, 5LZDF, 5LZDG, 5LZDH, 5LZDI, 5LZDJ, 5LZDK, 5LZDL, 5LZDM, 5LZDN, 5LZDO, 5LZDP, 5LZDQ, 5LZDR, 5LZDS, 5LZDT, 5LZDV, 5LZDW, 5LZDX, 5LZDY, 5LZDZ, 5LZEA, 5LZEB, 5LZEC, 5LZED, 5LZEE, 5LZEF, 5LZEG, 5LZEH, 5LZEI, 5LZEJ, 5LZEK, 5LZEL, 5LZEM, 5LZEN, 5LZEO, 5LZEP, 5LZEW, 5LZEX, 5LZEY, 5LZEZ, 5MVIG, 5NVIG, 5OVIG, 5PCBB, 5PCBM, 5PCCR, 5PCFT, 5PCIN, 5PCMM, 5PCST, 5PCWC, 7PAC1, 7PAC2, 7PAC3, 7PAC4, 51VIG, 52VIG, 53CDA, 53VIG, 54VIG, 55VIG, 56VIG, 57VIG, 58VIG, 5AVIG, 5BCBB, 5BCCR, 5BCFT, 5BCIN, 5BCMM, 5BCST, 5BCWC, 5BLBB, 5BLCR, 5BLFT, 5BLIN, 5BLMM, 5BLST, 5BLWC, 5BVIG, 5CVIG, 5DVIG, 5EVIG, 5FVIG, 5GVIG, 5HVIG, 5IVIG, 5JVIG, 5KVIG, 5L001, 5L002, 5L003, 5L006, 5L007, 5L008, 5L009, 5L010, 5L011, 5L012, 5L013, 5L014, 5L015, 5L016, 5L017, 5L018, 5L019, 5L022, 5L023, 5L024, 5L025, 5L026, 5L027, 5L030, 5L031, 5L032, 5L033, 5L041, 5L042, 5L045, 5L046, 5L049, 5L04A, 5L04B, 5L050, 5L051, 5L052, 5L053, 5L054, 5L055, 5L056, 5L057, 5L063, 5L064, 5L065, 5L066, 5L080, 5L081, 5L084, 5L085, 5L086, 5L087, 5L08A, 5L08B, 5L09A, 5L09B, 5L106, 5L107, 5L108, 5L109, 5L110, 5L111, 5L114, 5L131, 5L132, 5L133, 5L134, 5L135, 5L136, 5L139, 5L140, 5L143, 5L144, 5L145, 5L146, 5L147, 5L148, 5L149, 5L150, 5L151, 5L152, 5L153, 5L154, 5L159, 5L160, 5L163, 5L164, 5L173, 5L174, 5L177, 5L178, 5L179, 5L180, 5L181, 5L182, 5L183, 5L193, 5L194, 5L195, 5L196, 5L197, 5L198, 5L199, 5L200, 5L201, 5L202, 5L500, 5L501, 5L502, 5L503, 5L504, 5L505, 5L506, 5L507, 5L520, 5L521, 5L522, 5L523, 5L524, 5L525, 5L526, 5L527, 5L530, 5L532, 5L533, 5L534, 5L535, 5L536, 5L537, 5L538, 5L539, 5L540, 5L541, 5L542, 5L543, 5L544, 5L545, 5L546, 5L547, 5L548, 5L549, 5L550, 5L551, 5L552, 5LA55, 5LA56, 5LA57, 5LA58, 5LA59, 5LA60, 5LA61, 5LA62, 5LA63, 5LA64, 5LA65, 5LA66, 5LA67, 5LA68, 5LA69, 5LA70, 5LA71, 5LA72, 5LA73, 5LA74, 5LA75, 5LA76, 5LA79, 5LA80, 5LA82, 5LA83, 5LA85, 5LA86, 5LA87, 5LA90, 5LA96, 5LA99, 5LB00, 5LB01, 5LB02, 5LB03, 5LB05, 5LB06, 5LB07, 5LB08, 5LB09, 5LB10, 5LB11, 5LB12, 5LB13, 5LB14, 5LB15, 5LB16, 5LB19, 5LB20, 5LB21, 5LB22, 5LB23, 5LB24, 5LB25, 5LB26, 5LB27, 5LB28, 5LB29, 5LB30, 5LB31, 5LB32, 5LB33, 5LB34, 5LB35, 5LB36, 5LB37, 5LB38, 5LB39, 5LB40, 5LB61, 5LB62, 5LB63, 5LB64, 5LB65, 5LB66, 5LB67, 5LB71, 5LB72, 5LB73, 5LB74, 5LB75, 5LB76, 5LB77, 5LB78, 5LB79, 5LB80, 5LB81, 5LB82, 5LB83, 5LB84, 5LB85, 5LB86, 5LB87, 5LB88, 5LB89, 5LB90, 5LB91, 5LB92, 5LB93, 5LB94, 5LB95, 5LB96, 5LB97, 5LB98, 5LC01, 5LC02, 5LC03, 5LC04, 5LC05, 5LC06, 5LC07, 5LC08, 5LC09, 5LC10, 5LC11, 5LC12, 5LC13, 5LC45, 5LC46, 5LC47, 5LC48, 5LC49, 5LC50, 5LC51, 5LC52, 5LC53, 5LC54, 5LC55, 5LC56, 5LC57, 5LC58, 5LC59, 5LC60, 5LC63, 5LC64, 5LC73, 5LC74, 5LC75, 5LC76, 5LC81, 5LC82, 5LC83, 5LC84, 5LC85, 5LC86, 5LD00, 5LD01, 5LD02, 5LD06, 5LD07, 5LD08, 5LD09, 5LD10, 5LD11, 5LD12, 5LD13, 5LD14, 5LD15, 5LD16, 5LD17, 5LD18, 5LD55, 5LD56, 5LD57, 5LD58, 5LD59, 5LD61, 5LD62, 5LD63, 5LD64, 5LD65, 5LD66, 5LD80, 5LD81, 5LD82, 5LD83, 5LD84, 5LD85, 5LD86, 5LE10, 5LE11, 5LE12, 5LE13, 5LE14, 5LE15, 5LE20, 5LE21, 5LE22, 5LE23, 5LE24, 5LE25, 5LE26, 5LE27, 5LE28, 5LE29, 5LE30, 5LE31, 5LE32, 5LE33, 5LE34, 5LE35, 5LE36, 5LE37, 5LE38, 5LE39, 5LE40, 5LE41, 5LE42, 5LE44, 5LE45, 5LE46, 5LE47, 5LE80, 5LE81, 5LE82, 5LE83, 5LE84, 5LE85, 5LE86, 5LE87, 5LE88, 5LE89, 5LE90, 5LE91, 5LE92, 5LE93, 5LF00, 5LF01, 5LF02, 5LF03, 5LF04, 5LF05, 5LF06, 5LF07, 5LF55, 5LF56, 5LF57, 5LF58, 5LF59, 5LF60, 5LF75, 5LF76, 5LF77, 5LF78, 5LFT2, 5LFT3, 5LN00, 5LN01, 5LNE0, 5LNE1, 5LPT0, 5LPT1, 5LPT4, 5LPT5, 5LPT6, 5LPT7, 5LPT8, 5LPT9, 5LPTA, 5LPTB, 5LPTC, 5LPTD, 5LPTE, 5LPTF, 5LPTI, 5LPTJ, 5LPTM, 5LPTN, 5LPTO, 5LPTP, 5LPTQ, 5LPTR, 5LPTT, 5LPTU, 5LT01, 5LT02, 5LT03, 5LT04, 5LT05, 5LT06, 5LT07, 5LT08, 5LT09, 5LT10, 5LT11, 5LT12, 5LT13, 5LT14, 5LT17, 5LT18, 5LT19, 5LT20, 5LT22, 5LT23, 5LT25, 5LT26, 5LT27, 5LT28, 5LT29, 5LT30, 5LT31, 5LT32, 5LT40, 5LT41, 5LT45, 5LT46, 5LT47, 5LT48, 5LT52, 5LT53, 5LT55, 5LT56, 5LT57, 5LT58, 5LT61, 5LT62, 5LT63, 5LT64, 5LT65, 5LT66, 5LT67, 5LT68, 5LT69, 5LT70, 5LT71, 5LT72, 5LT73, 5LT74, 5LT75, 5LT76, 5LT79, 5LT80, 5LT81, 5LT82, 5LT83, 5LT84, 5LT85, 5LT86, 5LT87, 5LT88, 5LT89, 5LT90, 5LT91, 5LT92, 5LT93, 5LT94, 5LT95, 5LT96, 5LV1G, 5LV2G, 5LV3G, 5LV4G, 5LVIG, 5LZ02, 5LZ03, 5LZ04, 5LZ05, 5LZ06, 5LZ07, 5LZ08, 5LZ09, 5LZ12, 5LZ13, 5LZ14, 5LZ15, 5LZ16, 5LZ17, 5LZ18, 5LZ19, 5LZ20, 5LZ21, 5LZ22, 5LZ23, 5LZ24, 5LZ25, 5LZ26, 5LZ27, 5LZ28, 5LZ29, 5LZ30, 5LZ31, 5LZ34, 5LZ35, 5LZ36, 5LZ37, 5LZ38, 5LZ39, 5LZ40, 5LZ41, 5LZ42, 5LZ43, 5LZ44, 5LZ45, 5LZ46, 5LZ47, 5LZ48, 5LZ49, 5LZ50, 5LZ51, 5LZ52, 5LZ53, 5LZ54, 5LZ55, 5LZ56, 5LZ57, 5LZ58, 5LZ59, 5LZ60, 5LZ61, 5LZ62, 5LZ63, 5LZ64, 5LZ65, 5LZ66, 5LZ67, 5LZ68, 5LZ69, 5LZ70, 5LZ71, 5LZ72, 5LZ73, 5LZ74, 5LZ75, 5LZ76, 5LZ77, 5LZ78, 5LZ79, 5LZ80, 5LZ81, 5LZ82, 5LZ83, 5LZ84, 5LZ85, 5LZ86, 5LZ87, 5LZ88, 5LZ89, 5LZ93, 5LZ94, 5LZ95, 5LZ96, 5LZ97, 5LZ98, 5LZA1, 5LZA2, 5LZA5, 5LZA6, 5LZAC, 5LZAD, 5LZAE, 5LZAF, 5LZAG, 5LZAH, 5LZAI, 5LZAJ, 5LZAK, 5LZAL, 5LZAM, 5LZAN, 5LZAQ, 5LZAR, 5LZAW, 5LZAX, 5LZAY, 5LZAZ, 5LZB0, 5LZB1, 5LZB2, 5LZB3, 5LZB4, 5LZB5, 5LZB6, 5LZB7, 5LZB8, 5LZB9, 5LZBA, 5LZBB, 5LZBC, 5LZBD, 5LZBE, 5LZBF, 5LZBG, 5LZBH, 5LZBM, 5LZBN, 5LZBO, 5LZBP, 5LZBQ, 5LZBT, 5LZBU, 5LZBV, 5LZBW, 5LZBX, 5LZBY, 5LZBZ, 5LZCA, 5LZCB, 5LZCC, 5LZCD, 5LZCE, 5LZCF, 5LZCG, 5LZCH, 5LZCI, 5LZCJ, 5LZCK, 5LZCL, 5LZCM, 5LZCN, 5LZCO, 5LZCP, 5LZCQ, 5LZCR, 5LZCS, 5LZCT, 5LZCU, 5LZCV, 5LZCW, 5LZCX, 5LZCY, 5LZDA, 5LZDB, 5LZDC, 5LZDD, 5LZDE, 5LZDF, 5LZDG, 5LZDH, 5LZDI, 5LZDJ, 5LZDK, 5LZDL, 5LZDM, 5LZDN, 5LZDO, 5LZDP, 5LZDQ, 5LZDR, 5LZDS, 5LZDT, 5LZDU, 5LZDV, 5LZDW, 5LZDX, 5LZDY, 5LZDZ, 5LZEA, 5LZEB, 5LZEC, 5LZED, 5LZEE, 5LZEF, 5LZEG, 5LZEH, 5LZEI, 5LZEJ, 5LZEK, 5LZEL, 5LZEM, 5LZEN, 5LZEO, 5LZEP, 5LZEQ, 5LZER, 5LZES, 5LZET, 5LZEU, 5LZEV, 5LZEW, 5LZEX, 5LZEY, 5LZEZ, 5LZFA, 5LZFB, 5LZFC, 5LZFD, 5LZFE, 5LZFF, 5LZFG, 5LZFH, 5LZFI, 5LZFJ, 5MVIG, 5NVIG, 5OVIG, 5PCBB, 5PCCR, 5PCFT, 5PCIN, 5PCMM, 5PCST, 5PCWC, 5PLBB, 5PLBM, 5PLCR, 5PLFT, 5PLIN, 5PLMM, 5PLST, 5PLWC, 7JET3, 7PAC1, 7PAC2, 7PAC3, 7PAC4, 7RI28, 7RI29, 7RI36, 7RI37, 7RI38, 7RI39, 7RI41, 7RI42, 7RI43 |
Mammography Certification | 36428 | |
Managed Care Organization (MCO) or Health Maintenance Organization (HMO) Denials | MCO/HMO Name, Address, Plan Number, and Plan Type | 39001, U5233 |
Medicare Secondary Payer (MSP) Auto/No Fault | Insurer Name and Address, Effective and Term Date, MSP Type | 31308, 34009, 34010, 34011, 34087, 34088, 34089, 34090, 34133, 34138, 34139, 34140, 34141, 34142, 34271, 34277, 34287, 34299, 34311, 34365, 34372, 34383, 34384, 34507, 34551, 34544 |
Medicare Secondary Payer (MSP) Black Lung | Insurer Name and Address, Effective and Term Date, MSP Type | 34019, 34020, 34119, 34120, 34121, 34122, 34135, 34274, 34279, 34290, 34302, 34314, 34368, 34375, 34399, 34509, 34400, 34548, 37189 |
Medicare Secondary Payer (MSP) Conditional Payment | Insurer Name and Address, Effective and Term Date, MSP Type | 31406 |
Medicare Secondary Payer (MSP) Disability | Insurer Name and Address, Effective and Term Date, MSP Type | 34022 34023 34057 34099 34100 34101 34102 34115 34116 34117 34118 34129 34132 34157 34164 34257 34264 34267 34283 34286 34295 34298 34307 34310 34357 34371 34389 34390 34397 34398 34503 34515 34521 34530 34531 34536 34537 34540 34064 34506 34518 34524 34543 U680G |
Medicare Secondary Payer (MSP) ESRD/EGHP | Insurer Name and Address, Effective and Term Date, MSP Type | 34006, 34007, 34008, 34051, 34095, 34096, 34097, 34098, 34107, 34108, 34109, 34110, 34128, 34131, 34151, 34163, 34251, 34263, 34266, 34269, 34282, 34285, 34294, 34297, 34306, 34309, 34351, 34363, 34387, 34388, 34393, 34394, 34502, 34505, 34515, 34517, 34520, 34523, 34528, 34529, 34534, 34535, 34539, 34542 |
Medicare Secondary Payer (MSP) Information Incorrect | 77777 | |
Medicare Secondary Payer (MSP) Liability | Insurer Name and Address, Effective and Term Date, MSP Type | 34036, 34037, 34083, 34084, 34085, 34086, 34137, 34148, 34149, 34152, 34153, 34154, 34276, 34280, 34292, 34304, 34316, 34370, 34377, 34381, 34382, 34512, 34549, 34550, 37209, 39073 |
Medicare Secondary Payer (MSP) Missing or Invalid Payer Code | Insurer Name and Address, Effective and Term Date, MSP Type | 31300 |
Medicare Secondary Payer (MSP) Missing Value Code | Insurer Name and Address, Effective and Term Date, MSP Type | 31306 |
Medicare Secondary Payer (MSP) Value Code 44 Error | Insurer Name and Address, Effective and Term Date, MSP Type | 33981 |
Medicare Secondary Payer (MSP) Value Code Incorrect | 77775 | |
Medicare Secondary Payer (MSP) Workers’ Compensation | Insurer Name and Address, Effective and Term Date, MSP Type | 34012, 34013, 34014, 34079, 34080, 34081, 34082, 34134, 34143, 34144, 34145, 34146, 34147, 34272, 34278, 34288, 34300, 34312, 34366, 34373, 34378, 34379, 34380, 34508, 34525, 34545 |
Medicare Secondary Payer (MSP) Working Aged Denials | Insurer Name and Address, Effective and Term Date, MSP Type | 34002, 34003, 34004, 34050, 34060, 34070, 34062, 34066, 34091, 34092, 34093, 34094, 34103, 34104, 34105, 34106, 34127, 34130, 34150, 34162, 34250, 34262, 34265, 34268, 34270, 34281, 34284, 34293, 34296, 34305, 34308, 34350, 34362, 34364, 34385, 34386, 34391, 34392, 34450, 34462, 34465, 34468, 34471, 34474, 34477, 34480, 34483, 34486, 34489, 34492, 34495, 34498, 34501, 34504, 34513, 34516, 34519, 34522, 34526, 34527, 34532, 34533, 34538, 34541, U6803 |
Medicare Secondary Payer (MSP) Value Code submitted, Medicare is Primary | Insurer Name and Address, Effective and Term Date, MSP Type | 77745 |
Medically Unlikely Edit (MUE) Denials | Link to the Facility Outpatient Services MUE table located on the CMS website | 52MUE, 51MUE, 53MUE, 55MUE, 57MUE, 59MUE, 5BMUE, 5DMUE, 54MUE, 56MUE, 58MUE, 5AMUE, 5CMUE, 5EMUE |
Missing or Insufficient Documentation | 56900, 5PC01 5PC02 5PC03 5PC04 5PC12 5PC13 5PC14 5PC15 5PC16 5PC17 5PC18 | |
Missing or Invalid HCPCS | 32400, 32401, 32403, 32404 | |
Missing or Invalid MolDx Identifier | 5LZ00, 7LZ00, 7LZ02, 7LZ01, 7LZ03 | |
Multiple Observation Overlap | W7051 | |
National Correct Coding Initiative (NCCI) | Links to NCCI information and code pairs on CMS website | W7020, W7040, 55438, 55439 |
National Coverage Determination (NCD) Denials | NCD policy number and link to CMS website to view the policy. | 31763, 50129, 59001, 59002, 59004, 59006, 59008, 59011, 59012, 59013, 59014, 59015, 59016, 59017, 59018, 59019, 59020, 59021, 59022, 59023, 59024, 59025, 59026, 59027, 59028, 59029, 59030, 59031, 59032, 59033, 59034, 59035, 59036, 59037, 59038, 59039, 59040, 59041, 59042, 59043, 59044, 59045, 59046, 59047, 59048, 59049, 59050, 59051, 59052, 59053, 59054, 59055, 59056, 59057, 59058, 59059, 59060, 59061, 59062, 59063, 59064, 59065, 59066, 59067, 59068, 59069, 59070, 59071, 59072, 59073, 59074, 59075, 59076, 59079, 59080, 59081, 59082, 59083, 59084, 59085, 59086, 59087, 59088, 59089, 59090, 59091, 59092, 59093, 59094, 59095, 59096, 59097, 59098, 59099, 59100, 59101, 59102, 59103, 59104, 59105, 59106, 59107, 59108, 59109, 59110, 59112, 59113, 59114, 59115, 59116, 59117, 59118, 59119, 59120, 59121, 59122, 59123, 59124, 59125, 59126, 59127, 59128, 59129, 59130, 59131, 59132, 59133, 59134, 59135, 59136, 59137, 59138, 59139, 59140, 59141, 59142, 59143, 59144, 59145, 59146, 59147, 59148, 59149, 59150, 59151, 59152, 59153, 59154, 59155, 59156, 59157, 59158, 59159, 59161, 59162, 59163, 59164, 59165, 59166, 59167, 59170, 59171, 59172, 59173, 59174, 59175, 59176, 59177, 59180, 59181, 59182, 59183, 59186, 59187, 59190, 59191, 59192, 59193, 59194, 59195, 59196, 59197, 59198, 59199, 59201, 59202, 59203, 59204, 59205, 59206, 59207, 59208, 59209, 59210, 59211, 59212, 59234, 59235, 59236, 59237, 59238, 59239, 59240, 59241, 59242, 59243, 59244, 59245, 59246, 59247, 59248, 59249, 59266, 59271, 59272, 59273, 59274, 59275, 59276, 59277, 59278, 59279, 59280, 59281, 59282, 59283, 59284, 59285, 59286, 59287, 59288, 59289, 59290, 59291, 59292, 59293, 59294, 59295, 59296, 59297, 59298, 59299, 59300, 59301, 59302, 59303, 59304, 59305, 59306, 59311, 59312, 71755, 75013, 75294, 75727, 59C04, 59C05, 59C06, 59C07, 59C08, 59C09, 59C10, 59C13, 59C14, 59C15, 59C16, 59C17, 59C18, 59C19, 59C20, 59C21, 59C22, 59C23, 59C24, 59C25, 59C26, 59C27, 59C28, 59C29, 59C30, 59C31, 59C32, 59C33, 59C34, 59C40, 59C41, 59C42, 59C43, 59C48, 59C49, 5L189, 5L190, 5L191, 5L192, 5LD04, 5LN02, 5LN03, 5LN28, 5LN29, 5LN30, 5LN31, 5LN32, 5LN33, 5LN34, 5LN35, 5LN36, 5LN37, 5LN38, 5LZ91, 5LZ92, 5ND28, 5ND29, 5PEF1, 5PEF2, 7501A, 7501D, 7501E, 7501F, 7501G, 7501H, 7501I, 7501J, 7501K, 7572A, U523B, U523C, U5306, U5327, U5328, U5329, U5331, U537L, U537M, U5612, U5616 |
No Response to ADR | 39721 | |
OIG Audit | 7OIG2, 7OIG3, 7OIG5, 7OIG6 | |
Original Claim was Medically Reviewed | 30940 | |
Overlapping Claim Dates | Displays INPA information: NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient indicator | C7070 |
Outpatient Diagnostic Service within 72 Hours of an Inpatient Claim | C7113 | |
Part A Days Applied Incorrectly | 12206 | |
Patient Not Lawfully in the US | U538Q | |
PET Scan with no Valid Cancer Diagnosis | Link to the Medicare Coverage Database on the CMS website. | 7ICD7, 7ICD8, 7ICD9 |
Prostate Cancer Screening Test Frequency | Link to the Medicare Coverage Database and the Preventive Services tool on the CMS website. Eligibility link to Preventive Services. | U5383 |
Returned to Provider for Correction | 38305 | |
Service is After Beneficiary Date of Death | U5211, U5212 | |
Service not Billable under OPPS OCE | Links to Addendums on CMS Website | W7072 |
Skilled Nursing Facility (SNF) Claim does not meet Qualifying Stay | 13313, C7123 | |
Skilled Nursing Facility (SNF) Claim Sequence Error | 38119 | |
SNF Overlap Denials (Displays overlapping dates and any prior SNF claims) | Inpatient Stay/SNF Facility NPI, Start and End Date of Stay, Cancelled Date, Patient Status, Inpatient or Outpatient Indicator | C7251 |
Supplemental Medical Review Contractor (SMRC) | 7SMR0, 7SMR1, 7SMR2, 7SMR3, 7SMR4, 7SMR5, 7SMR6, 7SMR7, 7SMR8, 7SMR9 | |
Swing-Bed Billing Error | C7127 | |
Therapy Limit Exceeded | Displays Patient Therapy Cap Used | 7V822, 7V824 |
Veterans Administration (VA) Coverage | 34123, 34124, 34125, 34126, 34376, 34511, 34547, 34401, 34402, 37198 |
If you would like to suggest a denial category or denial reason code for the enhanced denial information, please let us know! Suggestions can be emailed to medicareadmin@wpsic.com. We update the denials often and would like to provide information that will help you be more efficient.
Part B Claim Categories with Enhanced Denial Information | Additional Information Available in Addition to Enhanced Denial Information |
---|---|
ADI Accreditation Not Found | Link to Advanced Diagnostic Imaging (ADI) Accreditation information on CMS website and link to MLN Matters article |
Add-On Code with no Primary Code | |
Alien Beneficiary | |
Always Therapy Code with no Modifier | Link to MLN Matters article and Outpatient Therapy Code Modifier information on our website |
Annual Wellness Visit (AWV) | Link to AWV booklet on CMS website |
Beneficiary Claims Under Jurisdiction of Railroad Retirement Board (RRB) | |
Beneficiary Eligibility | |
Beneficiary Record Deleted at Common Working File (CWF) | |
Billing and/or Rendering NPI Missing or Do Not Match | |
Billing Error/Overpayment | |
Chiropractic AT Modifier | |
Chiropractic Initial Treatment Date | Displays Link to CMS 1500 to ANSI 823 5010 Crosswalk |
Chiropractic Primary Secondary Diagnosis Incorrect/Missing | Displays Article or LCD policy number and link to CMS website |
Chiropractic Procedure Not Appropriate for Provider Specialty | |
Chiropractic X-ray Dates | |
CLIA Requirements | Link to Categorization of Tests on the CMS website |
CMS 1500 Form Item 11 | |
Diabetes Self-Management Training (DSMT) Certification | |
Duplicate Denials | CLAIM NUMBER of the claim causing the denial if it is available |
End Stage Renal Disease Prospective Payment System (ESRD PPS) | ESRD Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient |
Foot Care Modifier Required | |
Global Surgery – E/M Visit Same Day as Minor Surgery, Same Day or Day Prior to Major Surgery | Link to Global Surgery Modifier Fact Sheet on our portal |
Global Surgery – E/M Visit Within the Post-operative Period of a Major or Minor Surgery | Link to Global Surgery Modifier Fact Sheet on our portal |
Global Surgery - Major Surgery in the Post-Operative Period of another Surgery | Link to Global Surgery Modifier Fact Sheet on our portal |
Global Surgery – Postoperative Visit after Major or Minor Surgery with a 24 modifier | |
Global Surgery - Split Post-Operative Care Billing Error | Link to Global Surgery Modifier Fact Sheet on our portal |
Home Health Denials | Home Health NPI, Patient Status, Start and End Date, Earliest and Latest Billing Action Dates |
Home Health Physician Certification Frequency | |
Hospice Enrollment Denials | Displays Hospice NPI, start and end dates and revocation code |
Inactive Provider | Link to Medicare Provider Enrollment, Chain, and Ownership System (PECOS) |
Incarcerated Beneficiary | |
Initial Preventive Physical Examination (IPPE) | Link to IPPE Booklet on the CMS website |
Initial Preventive Physical Examination (IPPE) EKG | Link to IPPE Booklet on the CMS website |
Inpatient Service Submitted with Technical Component | Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient |
Invalid CRNA Modifier | |
Invalid Diagnosis Qualifier or Pointer | |
Invalid HCPCS Modifier | Links to Pricing Modifier Fact Sheet on the WPS website and the Physician Fee Schedule Search Tool on the CMS website |
Invalid HICN | |
Invalid MBI | |
Invalid Ordering or Referring Name or NPI | Link to CMS website to PECOS System, Order and Referring Data File and Ordering and Referring Information |
Invalid Place of Service | |
Invalid Provider | |
Lab Panel Unbundling | Link to NCCI page on CMS website |
Late Filing Denials | |
Local Coverage Decision (LCD) or Local Coverage Article (LCA) Denials | LCD or LCA policy number if available, and link to CMS website to view the policy |
Managed Care Organization (MCO) or Health Maintenance Organization (HMO) Denials | MCO/HMO Name, Address, Plan Number, and Plan Type |
Medicare Secondary Payer (MSP) Denials | Insurer Name and Address, Effective and Term Date, MSP Type |
Medicare Secondary Payer (MSP) Primary Explanation of Benefits does not Match Claim | |
Medically Unlikely Edit (MUE) Denials | Link to the Practitioner Services MUE table located on the CMS website |
More than One Evaluation and Management (E/M) Service | Link to Correct Submission of Multiple E&M Services on a Single Day on the our website |
More than One Evaluation and Management Visit per Day | |
Medicare Physician Fee Schedule Database (MPFSDB) Bundled or Excluded Service | |
Medicare Physician Fee Schedule Database (MPFSDB) Invalid or Non-Covered Service | |
National Correct Coding Initiative (NCCI) | Links to NCCI information and Code Pairs on CMS website CLAIM NUMBER of the claim causing the denial if it is available |
National Coverage Determination (NCD) Denials | NCD policy number if available, and link to CMS website to view the policy. |
New Patient Billing Error Denials | CLAIM NUMBER of the claim causing the denial if it is available |
No Response to ADR | |
Non-Physician Practitioners (NPP) Certification is Expired | Link to Medicare Provider Enrollment, Chain, and Ownership System (PECOS) |
Once per Beneficiary Lifetime Procedure | |
Opioid Treatment Program Service by Other than Specialty D5 | |
Opioid Use Disorder, CAP Exceeded for G2172 | |
Opioid Use Disorder, Diagnosis not Payable | |
Opioid Use Disorder, G2075 Not Appropriate | |
Opioid Use Disorder, Provider not Eligible | |
Opioid Use Disorder Services Submitted with non-Opioid Use Disorder Services | |
Ordering/Referring Provider Missing or Incorrect | |
Paid at Reasonable Charge Amount | |
Paid at Site of Service Fee Differential | Link to Physician Fee Schedule (PFS) Search Tool on the CMS website |
Part B Service Billed During an Inpatient Stay | Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient, link to Internet-Only Manual (IOM) |
Physical, Occupational, or Speech Language Pathology Therapy Limit Exceeded | Patient Therapy Cap used |
Place of Service Office (11), Patient in Facility Setting | Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient |
Podiatry Date Last Seen Missing | Link to Medicare Coverage Database on CMS website. Link to HIPAA Electronic Claim Submission Requirements: CMS 1500 to ANSI 823 5010 Crosswalk. |
Podiatry Diagnosis Not payable | Link to Medicare Coverage Database on CMS website. |
Pricing ZIP Code is not Valid | |
Pricing ZIP Code out of Jurisdiction | |
Prior Authorization Associated Service | Link to Prior Authorization for Hospital Outpatient Department Services (HOPD) page |
Psychology Diagnostic Evaluation Frequency | Link to Medicare Coverage Database on CMS website. |
Self-Administered Drug | Link to Medicare Coverage Database (MCD) |
Service is After Beneficiary Date of Death | |
Service not Valid with CS Modifier | |
SNF Consolidated Billing Denials | NPI Number, Start Date and End Date of Inpatient or SNF Claims, Cancelled Date, Patient Status, Inpatient or Outpatient |
Supplemental Medical Review Contractor (SMRC) | |
Surgery by More than One Physician | Link to Physician Fee Schedule (PFS) Search Tool on CMS website |
Treatment Deemed Experimental |
If you would like to suggest a denial category for the enhanced denial information, please let us know! Suggestions can be emailed to medicareadmin@wpsic.com. We update the denials often and would like to provide information that will help you be more efficient.
Part B Claim Categories with Enhanced Denial Information | Additional Information Available in Addition to Enhanced Denial Information |
---|---|
ADI Accreditation Not Found | Link to Advanced Diagnostic Imaging (ADI) Accreditation information on CMS website and link to MLN Matters article |
Add-On Code with no Primary Code | |
Alien Beneficiary | |
Always Therapy Code with no Modifier | Link to MLN Matters article and Outpatient Therapy Code Modifier information on our website |
Annual Wellness Visit (AWV) | Link to AWV booklet on CMS website |
Beneficiary Claims Under Jurisdiction of Railroad Retirement Board (RRB) | |
Beneficiary Eligibility | |
Beneficiary Record Deleted at Common Working File (CWF) | |
Billing and/or Rendering NPI Missing or Do Not Match | |
Billing Error/Overpayment | |
Chiropractic AT Modifier | |
Chiropractic Initial Treatment Date | Displays Link to CMS 1500 to ANSI 823 5010 Crosswalk |
Chiropractic Primary Secondary Diagnosis Incorrect/Missing | Displays Article or LCD policy number and link to CMS website |
Chiropractic Procedure Not Appropriate for Provider Specialty | |
Chiropractic X-ray Dates | |
CLIA Requirements | Link to Categorization of Tests on the CMS website |
CMS 1500 Form Item 11 | |
Diabetes Self-Management Training (DSMT) Certification | |
Duplicate Denials | CLAIM NUMBER of the claim causing the denial if it is available |
End Stage Renal Disease Prospective Payment System (ESRD PPS) | ESRD Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient |
Foot Care Modifier Required | |
Global Surgery – E/M Visit Same Day as Minor Surgery, Same Day or Day Prior to Major Surgery | Link to Global Surgery Modifier Fact Sheet on our portal |
Global Surgery – E/M Visit Within the Post-operative Period of a Major or Minor Surgery | Link to Global Surgery Modifier Fact Sheet on our portal |
Global Surgery - Major Surgery in the Post-Operative Period of another Surgery | Link to Global Surgery Modifier Fact Sheet on our portal |
Global Surgery – Postoperative Visit after Major or Minor Surgery with a 24 modifier | |
Global Surgery - Split Post-Operative Care Billing Error | Link to Global Surgery Modifier Fact Sheet on our portal |
Home Health Denials | Home Health NPI, Patient Status, Start and End Date, Earliest and Latest Billing Action Dates |
Home Health Physician Certification Frequency | |
Hospice Enrollment Denials | Displays Hospice NPI, start and end dates and revocation code |
Inactive Provider | Link to Medicare Provider Enrollment, Chain, and Ownership System (PECOS) |
Incarcerated Beneficiary | |
Initial Preventive Physical Examination (IPPE) | Link to IPPE Booklet on the CMS website |
Initial Preventive Physical Examination (IPPE) EKG | Link to IPPE Booklet on the CMS website |
Inpatient Service Submitted with Technical Component | Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient |
Invalid CRNA Modifier | |
Invalid Diagnosis Qualifier or Pointer | |
Invalid HCPCS Modifier | Links to Pricing Modifier Fact Sheet on the WPS website and the Physician Fee Schedule Search Tool on the CMS website |
Invalid HICN | |
Invalid MBI | |
Invalid Ordering or Referring Name or NPI | Link to CMS website to PECOS System, Order and Referring Data File and Ordering and Referring Information |
Invalid Place of Service | |
Invalid Provider | |
Lab Panel Unbundling | Link to NCCI page on CMS website |
Late Filing Denials | |
Local Coverage Decision (LCD) or Local Coverage Article (LCA) Denials | LCD or LCA policy number if available, and link to CMS website to view the policy |
Managed Care Organization (MCO) or Health Maintenance Organization (HMO) Denials | MCO/HMO Name, Address, Plan Number, and Plan Type |
Medicare Secondary Payer (MSP) Denials | Insurer Name and Address, Effective and Term Date, MSP Type |
Medicare Secondary Payer (MSP) Primary Explanation of Benefits does not Match Claim | |
Medically Unlikely Edit (MUE) Denials | Link to the Practitioner Services MUE table located on the CMS website |
More than One Evaluation and Management (E/M) Service | Link to Correct Submission of Multiple E&M Services on a Single Day on the our website |
More than One Evaluation and Management Visit per Day | |
Medicare Physician Fee Schedule Database (MPFSDB) Bundled or Excluded Service | |
Medicare Physician Fee Schedule Database (MPFSDB) Invalid or Non-Covered Service | |
National Correct Coding Initiative (NCCI) | Links to NCCI information and Code Pairs on CMS website CLAIM NUMBER of the claim causing the denial if it is available |
National Coverage Determination (NCD) Denials | NCD policy number if available, and link to CMS website to view the policy. |
New Patient Billing Error Denials | CLAIM NUMBER of the claim causing the denial if it is available |
No Response to ADR | |
Non-Physician Practitioners (NPP) Certification is Expired | Link to Medicare Provider Enrollment, Chain, and Ownership System (PECOS) |
Once per Beneficiary Lifetime Procedure | |
Opioid Treatment Program Service by Other than Specialty D5 | |
Opioid Use Disorder, CAP Exceeded for G2172 | |
Opioid Use Disorder, Diagnosis not Payable | |
Opioid Use Disorder, G2075 Not Appropriate | |
Opioid Use Disorder, Provider not Eligible | |
Opioid Use Disorder Services Submitted with non-Opioid Use Disorder Services | |
Ordering/Referring Provider Missing or Incorrect | |
Paid at Reasonable Charge Amount | |
Paid at Site of Service Fee Differential | Link to Physician Fee Schedule (PFS) Search Tool on the CMS website |
Part B Service Billed During an Inpatient Stay | Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient, link to Internet-Only Manual (IOM) |
Physical, Occupational, or Speech Language Pathology Therapy Limit Exceeded | Patient Therapy Cap used |
Place of Service Office (11), Patient in Facility Setting | Facility NPI, Start and End Date, Cancelled Date, Patient Status, Inpatient or Outpatient |
Podiatry Date Last Seen Missing | Link to Medicare Coverage Database on CMS website. Link to HIPAA Electronic Claim Submission Requirements: CMS 1500 to ANSI 823 5010 Crosswalk. |
Podiatry Diagnosis Not payable | Link to Medicare Coverage Database on CMS website. |
Pricing ZIP Code is not Valid | |
Pricing ZIP Code out of Jurisdiction | |
Prior Authorization Associated Service | Link to Prior Authorization for Hospital Outpatient Department Services (HOPD) page |
Psychology Diagnostic Evaluation Frequency | Link to Medicare Coverage Database on CMS website. |
Self-Administered Drug | Link to Medicare Coverage Database (MCD) |
Service is After Beneficiary Date of Death | |
Service not Valid with CS Modifier | |
SNF Consolidated Billing Denials | NPI Number, Start Date and End Date of Inpatient or SNF Claims, Cancelled Date, Patient Status, Inpatient or Outpatient |
Supplemental Medical Review Contractor (SMRC) | |
Surgery by More than One Physician | Link to Physician Fee Schedule (PFS) Search Tool on CMS website |
Treatment Deemed Experimental |
If you would like to suggest a denial category for the enhanced denial information, please let us know! Suggestions can be emailed to medicareadmin@wpsic.com. We update the denials often and would like to provide information that will help you be more efficient.
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