(Medicare Claims Processing Manual)

Z11.59 - Encounter for screening  for other  viral diseases , and,   Z72.89 - Other  problems  related  to lifestyle,  and, also  one of the following diagnosis  codes  below:   O09.90 Supervision of high risk pregnancy, unspecified, unspecified trimester  O09.91 Supervision of  high risk pregnancy, unspecified, first trimester  O09.92 Supervision of high risk pregnancy, unspecified, second trimester  O09.93 Supervision of high risk  pregnancy, unspecified, third trimester  230.4  Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages (Rev.11035, Issued:10 -13-21, Effective: 11-17-21; Implementation:  11-17-21)  Contractors shall use the appropriate claim adjustment reason codes (CARCs),  remittance  advice  remark codes  (RARCs),  group codes, or  Medicare summary  notice  (MSN) messages when rejecting  payment for  HBV screening:   Rejecting  services  submitted  on a TOB  other  than 13X, 14X, 72X, or 85X:  CARC 170 -  Payment  is denied  when  performed/billed  by this type  of provider. Note:  Refer  to the 835 Healthcare Policy  Identification  Segment  (loop 2110 Service Payment  Information  REF), if  present.   RARC N95   This  provider  type/provider  specialty  may not bill this  service.   MSN 21.25: This service was denied because Medicare only covers this service in  certain  settings.  Spanish Version:  El servicio  fue denegado porque  Medicare solamente  lo cubre  en ciertas  situaciones."   Group Code  CO (Contractual Obligation)  assigning financial liability  to the provider   a. Denying services where previous HBV screening, HCPCS G0499, is paid in history for claims with dates of service on and after September 28, 2016, or if the  beneficiarys claim history shows claim lines containing CPT codes 86704, 86706, 87340 and 87341 submitted in the  previous 11 full  months:   CARC 119:  Benefit  maximum for this time  period or  occurrence has been  reached.   RARC N386: This decision was based on a National Coverage Determination (NCD). An NCD provides  a coverage  determination  as to whether  a particular  item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not  have  web access,  you may contact  the contractor  to request  a copy of the NCD.   Group Code PR (Patient Responsibility) assigning financial responsibility to the  beneficiary  (if a claim  is received  with  occurrence code 32 with  or without  GA modifier  or a claim line  is received  with a  GA modifier  indicating a  signed ABN is  on file).   Group Code  CO (Contractual Obligation)  assigning financial  liability  to the provider  (if a  claim line -item is received with a GZ modifier indicating no signed ABN is on file and  occurrence code 32 is not  present).   (Part A only) MSN 15.19: Local Coverage Determinations (LCDs) help Medicare  decide what is covered. An LCD was used for your claim. You can compare your case to the LCD, and send information from your doctor if you think it could change our  decision. Call 1 -800MEDICARE  (1-800-633-4227)  for a copy  of the LCD.  Spanish Version -  Las Determinaciones Locales de Cobertura (LCDs en ingls) le ayudan a decidir a Medicare lo que est cubierto. Un LCD se us para su reclamacin.  Usted puede comparar su caso  con la determinacin y enviar informacin de su mdico si piensa  que puede cambiar  nuestra  decisin. Para obtener  una copia  del LCD,  llame  al 1-800-MEDICARE  (1800- 633-4227).  MSN 15.20: The following policies NCD 210.6 were used when we made this  decision.  Spanish Version  Las siguientes polticas NCD 210.6fueron utilizadas cuando se tom esta decisin.   NOTE:  Due to system  requirement, FISS has combined messages  15.19 and  15.20 so  that, when  used  for the  same  line item,  both messages  will appear  on the  same  MSN.    Denying services for HBV screening, HCPCS G0499, when ICD -10 diagnosis code  Z72.89 and  Z11.59 are  not present on the  claim:  CARC 167  This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy  Identification  Segment  (loop 2110 Service Payment Information  REF),  if present.   RARC N386 -  This decision was based on a National Coverage Determination (NCD). An NCD provides  a coverage  determination  as to whether  a particular  item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not  have  web access,  you may contact  the contractor  to request  a copy of the NCD.   (Part A only) MSN 15.19: Local Coverage Determinations (LCDs) help Medicare  decide what is covered. An LCD was used for your claim. You can compare your case to the LCD, and send information from your doctor if you think it could change our  decision. Call 1 -800-MEDICARE  (1-800-633-4227)  for a copy of the LCD.   Spanish Version -  Las Determinaciones Locales de Cobertura (LCDs en ingls) le ayudan a decidir a Medicare lo que est cubierto. Un LCD se us para su reclamacin.  Usted puede comparar su caso  con la determinacin y enviar informacin de su mdico si piensa  que puede cambiar  nuestra  decisin. Para obtener  una copia  del LCD,  llame  al 1-800-MEDICARE  (1-800-633-4227).   MSN 15.20: The following policies NCD 210.6 were used when we made this  decision. Spanish Version  Las siguientes polticas NCD 210.6 fueron utilizadas  cuando se  tom esta  decisin.   Group Code:  CO (Contractual  Obligation)   NOTE:  Due to system  requirement, FISS has combined messages  15.19 and  15.20 so  that, when  used  for the  same  line item,  both messages  will appear  on the  same  MSN.   Denying services for HBV screening, HCPCS G0499, for subsequent visits, when ICD-10 diagnosis code Z11.59, and one of the appropriate high- risk ICD -10 diagnosis  codes noted in section 230.3 are  not present on the  claim:   CARC 167  This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy  Identification  Segment  (loop 2110 Service Payment Information  REF),  if present.   RARC N386 -  This decision was based on a National Coverage Determination (NCD). An NCD provides  a coverage  determination  as to whether  a particular  item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not  have  web access,  you may contact  the contractor  to request  a copy of the NCD.   (Part A only) MSN 15.19: Local Coverage Determinations (LCDs) help Medicare decide what is covered. An LCD was used for your claim. You can compare your case to the LCD, and send information from your doctor if you think it could change our  decision. Call 1 -800-MEDICARE  (1-800-633-4227)  for a copy of the LCD.   Spanish Version -  Las Determinaciones Locales de Cobertura (LCDs en ingls) le ayudan a decidir a Medicare lo que est cubierto. Un LCD se us para su reclamacin.  Usted puede comparar su caso con la determinacin y enviar informacin de su mdico si piensa  que puede cambiar  nuestra  decisin. Para obtener  una copia  del LCD,  llame  al 1-800-MEDICARE  (1-800-633-4227).   MSN 15.20: The following policies NCD 210.6 were used when we made this  decision. Spanish Version  Las siguientes polticas NCD 210.6 fueron utilizadas  cuando se  tom esta  decisin.   Group Code:  CO (Contractual  Obligation)   NOTE:  Due to system  requirement, FISS has combined messages  15.19 and  15.20 so  that, when  used  for the  same  line item,  both messages  will appear  on the  same  MSN.    Denying claim lines for HBV screening, HCPCS G0499, without the appropriate  POS code:   CARC 171  Payment is denied when performed by this type of provider on this type of  facility. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment  Information REF), if  present.   RARC N428 - Not covered  when  performed  in certain  settings.  Group Code: CO  (Contractual Obligation)  MSN 21.25 -  This service was denied because Medicare only covers this service in  certain  settings.  Spanish Version:  El servicio  fue denegado  porque  Medicare solamente  lo cubre  en ciertas  situaciones."    Denying claim lines for HBV screening, HCPCS G0499, that are not submitted from  the appropriate  provider  specialties:   CARC 184 -  The prescribing/ordering provider is not eligible to prescribe/order the  service billed.  NOTE:  Refer  to the 835 Healthcare Policy  Identification  Segment  (loop 2110 Service Payment  Information REF),  if present.  RARC N386 -  This decision was based on a National Coverage Determination (NCD).  An NCD provides a coverage determination as to whether a particular item or service is  covered. A copy of this policy is available at www.cms.gov/mcd/search.asp on the CMS  website. If you do not have web access, you may contact the contractor to request a copy of the NCD.   MSN  21.18 -  This  item  or service is not covered when  performed or ordered  by this provider.  Spanish Version: Este servicio no esta cubierto cuando es ordenado o rendido por este  proveedor.   MSN 15.20: The following policies NCD 210.6 were used when we made this  decision.  Spanish Version  Las siguientes polticas NCD 210.6 fueron utilizadas cuando se tom esta decisin.   Group Code PR (Patient Responsibility) assigning financial responsibility to the  beneficiary  (if a claim  is received with  a GA modifier  indicating  a signed ABN is on file).   Group Code CO (Contractual Obligation) assigning financial liability to the provider (if a  claim  line-item is  received with  a GZ modifier  indicating  no signed ABN is on file).   NOTE:  For modifier  GZ, use CARC 50  and MSN  8.81.   Denying services where previous HBV screening, HCPCS 86704, 86706, 87340 or 87341, is paid during the same pregnancy period or more than two screenings are paid to women that are  at high risk:   CARC 119:  Benefit  maximum for this time  period or  occurrence has been  reached.   RARC N362: The number of days or units of service exceeds our acceptable  maximum.   RARC N386  This decision was based on a National Coverage Determination (NCD). An NCD provides  a coverage determination  as to whether  a particular  item or  service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp on the CMS  website. If you do not have web access, you may contact the contractor to request a copy of the NCD.