Medicare denial codes

D1 Claim/service denied. Level of subluxation is missing or inadequate.
D2 Claim lacks the name, strength, and dosage of the drug furnished.
D3 Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing.
D4 Claim/service does not indicate the period of time for which this will be needed.
D5 Claim/service denied. Claim lacks individual lab codes included in the test.
D6 Claim/service denied. Claim did not include patient’s medical record for the service.
D7 Claim/service denied. Claim lacks date of patient’s most recent physician visit.
D8 Claim/service denied. Claim lacks indicator that “xray is available for review.”
D9 Claim/service denied. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used.
D10 Claim/service denied. Completed physician financial relationship form not on file.
D11 Claim lacks completed pacemaker registration form.
D12 Claim/service denied. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test.
D13 Claim/service denied. Performed by a facility/supplier in which the ordering/referring physician has a financial interest.

Remark codes must be used to relay service-specific Medicare informational messages that cannot expressed with a reason code. Medicare remark codes are maintained by HCFA.
Remark codes and messages must be used whenever they apply. Although contractors may use their discretion to determine when certain remark codes apply, they do not have discretion as to whether to use an applicable remark code in a remittance notice. A limitation of liability message (m25-M27) must be used where applicable. An unlimited number of Medicare line level remark codes may be entered as warranted in an X12 835 Remittance Advice; there is a limit of 5 line level remark code entries in a NSF Remittance Advice and on a standard paper remittance notice.
a. Line Level Remark Codes
Code Value Description

M1 X-ray not taken within the past 12 months or near enough to the start of treatment.
M2 Not paid separately when the patient is an inpatient.
M3 Equipment is the same or similar to equipment already being used.
M4 This is the last monthly installment payment for this durable medical equipment.
M5 Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
M6 You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for every 6 month period after the end of the 15th paid rental month or the end of the warranty period.
M7 No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.
M8 We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
M9 This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
M10 Equipment purchases are limited to the first or the tenth month of medical necessity.

Medicare denial reason code -1
Medicare denial reason code – 2
Medicare denial reason code – 3
Denial EOB
Medicare EOB
Denial claim example
Denial claim
Medicare denial codes
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1 Comments.

  1. What does Medicare denial code CO226 mean in layman terms? Why isn’t there a book for this? If I knew what all the denials actually meant, I would write the book myself!! Medicare denial codes for dummies!!!!

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