evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
cocaine -induced  anxiety  disorder  F14.981  Cocaine  use, unspecified  with cocaine -induced  sexual  dysfunction  F14.982  Cocaine  use, unspecified  with cocaine -induced  sleep  disorder  F14.988  Cocaine  use, unspecified  with other  cocaine -induced  disorder  F15.10  Other  stimulant  abuse,  uncomplicated  F15.11  Other  stimulant  abuse,  in remission  F15.120  Other  stimulant  abuse  with intoxication,  uncomplicated  F15.121  Other  stimulant  abuse  with intoxication  delirium  F15.122  Other  stimulant  abuse  with intoxication  with perceptual  disturbance  F15.129  Other  stimulant  abuse  with intoxication,  unspecified  F15.13  Other  stimulant  abuse  with withdrawal  F15.14  Other  stimulant  abuse  with stimulant -induced  mood  disorder   F15.150  Other  stimulant  abuse  with  stimulant -induced  psychotic  disorder  with  delusions  F15.151  Other  stimulant  abuse  with  stimulant -induced  psychotic  disorder  with  hallucinations  F15.159  Other  stimulant  abuse  with  stimulant -induced  psychotic  disorder,  unspecified  F15.180  Other  stimulant  abuse  with  stimulant -induced  anxiety  disorder  F15.181  Other  stimulant  abuse  with  stimulant -induced  sexual  dysfunction  F15.182  Other  stimulant  abuse  with  stimulant -induced  sleep  disorder  F15.188  Other  stimulant  abuse  with  other  stimulant -induced  disorder  F15.20  Other  stimulant  dependence,  uncomplicated  F15.21  Other  stimulant  dependence,  in remission  F15.220  Other  stimulant  dependence  with  intoxication,  uncomplicated  F15.221  Other  stimulant  dependence  with  intoxication  delirium  F15.222  Other  stimulant  dependence  with  intoxication  with  perceptual  disturbance  F15.229  Other  stimulant  dependence  with  intoxication,  unspecified  F15.23  Other  stimulant  dependence  with  withdrawal  F15.24  Other  stimulant  dependence  with  stimulant -induced  mood  disorder  F15.250  Other  stimulant  dependence  with  stimulant -induced  psychotic  disorder  with  delusions  F15.251  Other  stimulant  dependence  with  stimulant -induced  psychotic  disorder  with
(Medicare Claims Processing Manual)
stimulant -induced  mood  disorder  F15.250  Other  stimulant  dependence  with  stimulant -induced  psychotic  disorder  with  delusions  F15.251  Other  stimulant  dependence  with  stimulant -induced  psychotic  disorder  with  hallucinations  F15.259  Other  stimulant  dependence  with  stimulant -induced  psychotic  disorder,  unspecified  F15.280  Other  stimulant  dependence  with  stimulant -induced  anxiety  disorder  F15.281  Other  stimulant  dependence  with  stimulant -induced  sexual  dysfunction  F15.282  Other  stimulant  dependence  with  stimulant -induced  sleep  disorder  F15.288  Other  stimulant  dependence  with  other  stimulant -induced  disorder  F15.90  Other  stimulant  use, unspecified,  uncomplicated  F15.920  Other  stimulant  use, unspecified  with  intoxication,  uncomplicated  F15.921  Other  stimulant  use, unspecified  with  intoxication  delirium  F15.922  Other  stimulant  use, unspecified  with  intoxication  with  perceptual  disturbance  F15.929  Other  stimulant  use, unspecified  with  intoxication,  unspecified  F15.93  Other  stimulant  use, unspecified  with withdrawal  F15.94  Other  stimulant  use, unspecified  with  stimulant -induced  mood  disorder  F15.950  Other  stimulant  use, unspecified  with  stimulant -induced  psychotic  disorder with  delusions  F15.951  Other  stimulant  use, unspecified  with  stimulant -induced  psychotic  disorder with  hallucinations  F15.959  Other  stimulant  use, unspecified  with  stimulant -induced  psychotic  disorder,  unspecified  F15.980  Other  stimulant  use, unspecified  with  stimulant -induced  anxiety  disorder  F15.981  Other  stimulant  use, unspecified  with  stimulant -induced  sexual  dysfunction  F15.982  Other  stimulant  use, unspecified  with  stimulant -induced  sleep  disorder  F15.988  Other  stimulant  use, unspecified  with  other  stimulant -induced  disorder  Z20.2  Contact  with  and (suspected)  exposure  to infections  with  a predominantly  sexual  mode  of transm  Z20.5  Contact  with  and (suspected)  exposure  to viral  hepatitis  Z72.52  High  risk homosexual behavior  Z72.53  High  risk bisexual  behavior
(Medicare Claims Processing Manual)
For claims with dates of service on or after September 28, 2016, CMS will allow  coverage for HBV screening (CPT codes 86704, 86706, 87340 and 87341) in pregnant  women  only when  services  are reported  with the following diagnosis  codes:   Z11.59 -  Encounter for screening for other viral diseases, and one of the following  diagnosis  codes below:   Z34.00 Encounter  for supervision of  normal  first pregnancy,  unspecified  trimester  Z34.01 Encounter for supervision of normal first pregnancy, first trimester  Z34.02 Encounter for supervision of normal first pregnancy, second trimester  Z34.03  Encounter  for supervision of normal first pregnancy, third trimester  Z34.80 Encounter  for supervision of other  normal  pregnancy, unspecified  trimester  Z34.81 Encounter  for supervision of other  normal  pregnancy, first trimester  Z34.82 Encounter for supervision of other normal pregnancy, second trimester  Z34.83  Encounter  for supervision of other normal pregnancy, third trimester  Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester  Z34.91 Encounter  for supervision of normal  pregnancy, unspecified, first trimester  Z34.92 Encounter for supervision of normal pregnancy, unspecified, second trimester  Z34.93  Encounter  for supervision of normal pregnancy, unspecified, third trimester  For claims with dates of service on or after September 28, 2016, CMS  will allow coverage for HBV screening (CPT codes 86704, 86706, 87340 and 87341) in pregnant women at high risk only when services  are reported with the  following diagnosis codes:   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:
(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.
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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)
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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.   (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).
(Medicare Claims Processing Manual)
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  and occurrence code  32 is not present)   Group Code CO (Contractual Obligation) assigning financial liability to the provider (if a  claim is received with occurrence code 32 with or without a GZ modifier indicating no signed ABN is on file).   b. Denying services for HBV screening, HCPCS G0499, when ICD -10 diagnosis code  Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91, O09.92, or  O09.93 is 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.   Group Code:  CO (Contractual  Obligation)   (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.
(Medicare Claims Processing Manual)
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.   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 for a subsequent HBV  screening  test for non-pregnant, high risk  beneficiary  when  a claim  line for an  initial HBV screening  has not  yet been posted in history:   CARC 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.   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 (Contractual  Obligation).  MSN  21.21:  This  service was  denied  because Medicare only covers  this service under  certain  circumstances.  Spanish Version  - Este servicio  fue denegado  porque  Medicare solamente lo cubre  bajo ciertas  circunstancias.
(Medicare Claims Processing Manual)
(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.   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   240 - Prolonged Preventive Services Codes  (Rev.  3844, Issued: 08- 18-17, Effective: 01 -01-18, Implementation: 01- 02-18)  Effective for claims with dates of service on or after January 1, 2018, prolonged preventive services (PPS) may be reported as an add- on to a covered preventive service that is payable from the Medicare Physician Fee Schedule.   PPS codes are treated as a preventive service and both coinsurance and deductible do not apply when billed with a covered preventive service which is part of a particular subset of procedure codes listed at https://www.cms.gov/Medicare/Medicare -Fee-for-Service-Payment/PhysicianFeeSched/Medicare- PFS-Preventive -Services.html
(Medicare Claims Processing Manual)
Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Implementation Date  CR#  R12435CP  12/28/2023 Update to the Internet Only Manual (IOM) Publication (Pub.) 100- 04, Chapter 18, Sections 20.2, 60.3 and Chapter 32, Sections 50.4.1, 200.2 for Coding Revisions to the National Coverage Determinations (NCDs) --April 2024 Change Request (CR) 13391 01/29/2024 13461  R12299CP   10/12/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening -  Full Agile Pilot CR  11/13/2023 13017  R12070CP  06/07/2023 Internet Only Manual Update to Publication 100- 04, Chapters 9 and 18 to Clarify Vaccine Payment Instructions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)  07/10/2023 13218  R11902CP  03/16/2023 Update to the Internet Only Manual (IOM) Publication (Pub.) 100- 04, Chapter 18 Sections 50.3- 50.4, and Chapter 32 Sections 130.1, 170.2 for Coding Revisions to National Coverage Determinations (NCDs) --July 2023 Change Request (CR) 13070 04/17/2023 10104  R11865CP  02/16/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening -  Full Agile Pilot CR  Rescinded and replaced by  Transmittal 02/27/2023 13017  Rev #  Issue Date  Subject  Implementation Date  CR#  12299