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Appeal Denial Crosswalk

Updated: 03.20.18

REMITTANCE ADJUSTMENT REASON CODE (RARC) DISPLAYED ON THE REMITTANCE ADVICE (RA)	DESCRIPTION	CLAIM ADJUSTMENT REASON CODE (CARC) DISPLAYED ON REMITTANCE ADVICE (RA)	GENERIC DENIAL CODE	GENERIC REASON STATEMENT
N522	THIS IS A DUPLICATE CLAIM BILLED BY THE SAME PROVIDER	18	GBA01	THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY THE SAME PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3
N522	THIS IS A DUPLICATE CLAIM BILLED BY DIFFERENT PROVIDER	18	GBA02	THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY A DIFFERENT PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3
N706	NO RECORDS WERE SUBMITTED	250	GBB01	THE REQUESTED RECORDS WERE NOT RECEIVED. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8
N705	INCOMPLETE/ INSUFFICIENT DOCUMENTATION	251	GBB02	THE DOCUMENTATION SUBMITTED WAS INCOMPLETE AND/OR INSUFFICIENT. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8, B/C
N163	THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE	150	GBB03	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT SERVICES WERE RENDERED AS BILLED. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A
N455	DOES NOT CONTAIN PROVIDER ORDER	251	GBB04	THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A PHYSICIAN ORDER. REFER TO IOM, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2
N382	MISSING PATIENT IDENTIFIERS	16	GBB05	THE DOCUMENTATION SUBMITTED WAS MISSING PATIENT IDENTIFIERS. REFER TO STANDARDS FOR ADEQUACY OF MEDICAL RECORDS; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT
M53	INCORRECT DATE OF SERVICE	110	GBB06	THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT DATE OF SERVICE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2
N519	INCORRECT MODIFIER	4	GBB07	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MODIFIERS BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, IOM PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1
N563	ABN DENIAL	116	GBB08	THE ABN IS INVALID, INCOMPLETE OR MISSING. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 40.3.6
MA36	THE BENEFICIARY NAME ON THE DOCUMENTATION DOES NOT MATCH WHAT IS ON THE CLAIM	16	GBB09	THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT BENEFICIARY. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8
N205	ILLEGIBLE DOCUMENTATION	50	GBB10	THE DOCUMENTATION SUBMITTED IS NOT LEGIBLE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3 SECTION 3.3.2.1
M53	THE DOCUMENTATION DOES NOT SUPPORT THE NUMBER OF UNITS BILLED	222	GBB11	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE NUMBER OF UNITS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23
N661	DOES NOT MEET MEDICAL NECESSITY	50	GBC01	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY AS LISTED IN COVERAGE REQUIREMENT. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2
N661	DOES NOT MEET MEDICAL NECESSITY	50	GBC02	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.1, 3.6.2.2
N643	NON COVERED SERVICE	96	GBC03	THE SERVICE BILLED IS NOT A COVERED MEDICARE BENEFIT OR IS AN EXCLUDED SERVICE. REFER TO 42 CFR 411.15. MEDICARE BENEFIT POLICY MANUAL CHAPTER 16; CFR TITLE 42, CHAPTER IV, SUBCHAPTER B, PART 411
N435	DOES NOT SUPPORT NUMBER OF SERVICES FOR TIMEFRAME	151	GBC04	THE DOCUMENTATION PROVIDED DOES NOT SUPPORT THE MEDICAL NECESSITY FOR THIS NUMBER OF SERVICES OR ITEMS WITHIN THIS TIMEFRAME. REFER TO SSA 1862, IOM, 100-08, MPIM CHAPTER 3, SECTION 3.6.2.2
N362	THE MAX BENEFIT AS BEEN REACHED FOR THIS SERVICE	114	GBC05	THE MAXIMUM BENEFIT HAS BEEN REACHED FOR THIS SERVICE. REFER TO IOM, PUB 100-02, MEDICARE BENEFIT POLICY MANUAL CHAPTER 5 AND IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5 A
N429	SERVICE WAS PERFORMED FOR ROUTINE/SCREENING BUT IS NOT A COVERED MEDICARE SCREENING BENEFIT	96	GBC06	THE DOCUMENTATION INDICATES THAT THE SERVICE WAS PERFORMED FOR ROUTINE/SCREENING PURPOSES BUT IS NOT COVERED UNDER MEDICARE’S SCREENING BENEFIT. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 18
N705	BILLING ERROR	16	GBD01	BILLING ERROR. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4; 100-04 MEDICARE CLAIMS PROCESSING MANUAL, CHAPTER 23.
M15	BUNDLED OR INCLUDED IN ANOTHER CODE BILLED	97	GBD03	BUNDLED OR INCLUDED IN ANOTHER CODE BILLED (NCCI). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 20.3; NATIONAL CORRECT CODING INITIATIVE CODING POLICY MANUAL FOR MEDICARE SERVICES; MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1
N163	DOES NOT SUPPORT SERVICE BILLED	50	GBD04	THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE WAS PERFORMED AS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23
M64	DOES NOT SUPPORT DIAGNOSIS	11	GBD05	THE DOCUMENTATION DOES NOT SUPPORT THE DIAGNOSIS CODE BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1
N525	GLOBAL SURGERY PERIOD	97	GBD06	PAYMENT FOR THIS SERVICE IS COMPENSATED IN THE GLOBAL SURGICAL PERIOD. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12 SECTION 30.6.6
M15	BUNDLED IN ANOTHER SERVICE ON THE SAME DOS	97	GBD07	PAYMENT IS INCLUDED IN ANOTHER SERVICE RECEIVED ON THE SAME DATE (BUNDLED). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30 & 40
MA50	INVESTIGATIONAL	55	GBD08	THIS SERVICE OR PROCEDURE IS CONSIDERED INVESTIGATIONAL AND, THEREFORE, NOT COVERED BY MEDICARE. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2
N163	DOES NOT SUPPORT ORDERED SERVICE	50	GBD09	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE ORDERED SERVICE. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A
N519	DOES NOT SUPPORT CPT MODIFIER 25	236	GBD10	THE DOCUMENTATION DOES NOT SUPPORT THAT A SEPARATELY IDENTIFIABLE SERVICE WAS PERFORMED. REFER TO IOM MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30.6; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT
N19	APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID	96	GBD11	THE APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.4
N383	COSMETIC PURPOSES	96	GBD12	THE DOCUMENTATION SUBMITTED INDICATES THE SERVICE WAS PERFORMED FOR COSMETIC PURPOSES. REFER TO MEDICARE BENEFIT POLICY MANUAL CHAPTER 16, SECTION 120
N163	CLONED DOCUMENTATION	50	GBD13	THE DOCUMENTATION SUBMITTED CONTAINS CLONED OR ALTERED INFORMATION. REFER TO PUB 100-8, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.3.2.5; CHAPTER 4.3
N705	BILLING ERROR	250	GBD14	THE PROVIDER INDICATED SERVICES WERE BILLED IN ERROR. REFER TO SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT
N206	DOCUMENT CONTAINS CONFLICTING INFORMATION	50	GBD15	THE DOCUMENTATION CONTAINS CONFLICTING INFORMATION. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.3
M102	NOT FDA APPROVED	55	GBD16	THE SERVICE OR DEVICE WAS NOT FDA APPROVED. REFER TO SSA 1862; MEDICARE BENEFIT POLICY MANUAL CHAPTER 14
N425	STATUTORILY EXCLUDED	96	GBD17	THE SERVICE BILLED IS STATUTORILY EXCLUDED. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 20.1.1, SOCIAL SECURITY ACT 1862 (A), 12 CFR 411.15, MEDICARE BENEFIT POLICY MANUAL CHAPTER 16
N55	PERFORMING PROVIDER IS NOT BILLING PROVIDER	B20/16	GBD18	THE DOCUMENTATION SUBMITTED SUPPORTS THE PERFORMING AND BILLING PROVIDERS ARE DIFFERENT
M25	DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED	150	GBE01	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MEDICAL NECESSITY OF THE LEVEL OF SERVICE BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23
M25	DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED	150	GBE02	THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.4
MA81	INVALID SIGNATURE OR CREDENTIALS	50	GBF01	THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND/OR CREDENTIALS. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24
MA81	NO RESPONSE TO ATTESTATION OR SIGNATURE LOG	16	GBF02	THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND A RESPONSE TO ATTESTATION OR SIGNATURE LOG REQUEST WAS NOT RECEIVED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24
MA81	STAMPED SIGNATURE	50	GBF03	STAMPED SIGNATURES ARE NOT ACCEPTED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4
N170	DID NOT INCLUDE REQUIRED CERTIFICATIONS	50	GBG01	THE DOCUMENTATION SUBMITTED DID NOT INCLUDE THE REQUIRED CERTIFICATIONS OR RECERTIFICATIONS. REFER TO MEDICARE BENEFIT POLICY MANUAL, CHAPTER 15, 220.1.3
MA81	NOT A VALID NPI	207	GBH01	THE CLAIM DID NOT INCLUDE A VALID NPI. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1, SECTION 80.3.1
N705	DID NOT CONTAIN REQUIRED INFORMATION	50	GBH02	THE CLAIM SUBMITTED DID NOT CONTAIN REQUIRED INFORMATION

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Appeal Denial Crosswalk

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