(Medicare Claims Processing Manual)

Effective for dates of service on or after December 8, 2009, when denying claims for HIV screening, HCPCS codes G0432, G0433, or G0435, submitted without ICD -9/ICD -10 diagnosis codes V73.89/Z11.4, or V73.89/Z11.4 and V69.8/Z72.89, use the following message s:  Medicare Summary Notice (MSN) 16.10 -  Medicare does not pay for this item or service.   Medicare no paga por este articulo o servicio   Claim Adjustment Reason Code (CARC) 167-  This (these) diagnosis(es) is (are) not covered.   Group Code CO -  (Contractual Obligation)    Effective for dates of service on or after December 8, 2009, when denying claims for HIV screening, HCPCS codes G0432, G0433, or G0435, over the benefit maximum, use the following denial messages:   MSN 15.22  The information provided does not support the need for this many services or items in this period of time so Medicare will not pay for this item or service.   La informac n proporcionada no justifica la necesidad de esta cantidad de servicios o articulos en este periodo de tiempo por lo cual Medicare no pagar  por este articulo o servicio.   CARC 119  Benefit maximum for this time period or occurrence has been reached.   Group Code CO -  (Contractual obligation).    Effective for dates of service on or after April 13, 2015 , when denying claims for HIV screening, HCPCS code G0432, G0433, G0435, G0475 or  CPT -80081 for more than three in a pregnancy term, use the following denial messages:   CARC 119  Benefit maximum for this time period or occurrence has been reached.   Remittance Advice Remark Code (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. Cal l 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 pie nsa 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 NCD210.7 were used when we made this decision.   Spanish Version  Las siguientes polticas NCD210.7 fueron 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.   MSN: 15.22: The information provided does not support the need for this many services or items in this period of time so Medicare will not pay for this item or service.   Spanish Version  La informacin proporcionada no justifica la necesidad de esta cantidad de servicios o artculos en este periodo de tiempo por lo cual Medicare no pagar por este artculo o servicio.   Group Code -  CO   Effective for dates of service on or after April 13, 2015, when denying claims for HIV screening, HCPCS code G0475, if ICD -9/ICD -10 primary diagnosis code V73.89/Z11.4 and one of the following secondary ICD -9/ICD -10 diagnosis codes: V69.2/Z72.51, V69.8/Z72.89, V69.2/Z72.52, or V69.2/Z72.53 are not present and the beneficiary is less than 15 and greater than 65 years of age, use the following messages:   CARC 6: The procedure/revenue code is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.   RARC N129: Not eligible due to the patients age.   (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.  Ca ll 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 pie nsa 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 NCD210.7 were used when we made this decision."   Spanish Version  Las siguientes polticas NCD210.7 fueron 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.   Group Code -  CO   Effective for dates of service on or after April 13, 2015, when denying claims for HIV screening, HCPCS code G0475, G0432, G0433, or G0435 is not submitted with the appropriate, primary ICD -9/ICD -10 diagnosis code V73.89/Z11.4, , use the following messages:   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. Cal l 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 pie nsa 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 NCD210.7 were used when we made this decision.   Spanish Version  Las siguientes polticas NCD210.7 fueron 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.   Group Code -  CO  Effective for dates of service on or after April 13, 2015, when denying claims for HIV screening, HCPCS code G0475, billed more than once per annum [at least 11 full months must elapse from the date of the last screening], use the following messages:   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.   (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.  Ca ll 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 pie nsa 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 policy NCD210.7 was used when we made this decision   Spanish Version  Las siguientes polticas NCD210.7 fueron 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.   Group Code -  CO   Effective for dates of service on or after April 13, 2015, when denying claims for HIV screening, HCPCS G0475 or  CPT -80081 if ICD -9/ICD -10 primary diagnosis code V73.89/Z11.4 and one of the following ICD -9/ICD -10 secondary diagnosis codes are not present for pregnant beneficiaries as listed in section 130.5 (c), use the following denial messages:   CARC 11: The diagnosis is inconsistent with the procedure.  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.   Group Code CO   (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.  Ca ll 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 pie nsa 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 NCD210.7 were used when we made this decision.   Spanish Version  Las siguientes polticas NCD210.7 fueron utilizadas cuando se tom esta decision.