Medicare eob reason codes

101 Predetermination: anticipated payment upon completion of services or claim adjudication.
102 Major Medical adjustment. (Not Medicare).
103 Provider promotional discount (i.e. Senior citizen discount). (Not Medicare).
104 Managed care withholding.
105 Tax withholding. (Not Medicare).
106 Patient payment option/election not in effect.
107 Claim/service denied because the related or qualifying claim/service was not paid or identified on the claim.
108 Claim/service denied/reduced because rent/purchase guidelines were not met.
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
110 Billing date predates service date.
111 Not covered unless the provider accepts assignment.
112 Claim/service denied/reduced as not furnished directly to the patient and/or not documented.
113 Claim denied because service/procedure was provided outside the United States or as a result of war.
114 Procedure/product not approved by the Food and Drug Administration.
115 Claim/service denied/reduced as procedure postponed or canceled.
116 Claim/service denied. The advance indemnification notice signed by the patient did not comply with requirements.
117 Claim/service denied/reduced because transportation is only covered to the closest facility that can provide the necessary care.
118 Charges reduced for ESRD network support.
119 Benefit maximum for this time period has been reached.
120 Patient is covered by a managed care plan.
121 Indemnification Adjustment.
122 Psychiatric reduction.
123 Payer refund amount due to overpayment.
124 Payer refund amount – not our patient.
125 Claim/service denied/reduced due to a submission/billing error.
126 Deductible — Major Medical
127 Coinsurance — Major Medical
128 Newborn’s services are covered in the mother’s allowance.
129 Claim denied – Prior processing information appears incorrect.
130 Paper calim submission fee.
131 Claim specific negotiated discount.
132 Prearranged demonstration project adjustment.
133 This service is suspended pending further review.
134 Technical fees removed from charges.
135 Claim denied. Interim bills cannot be processed.
136 Claim Denied/Reduced. Plan procedures of a prior payer were not followed.
137 Payment/Reduction for Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.

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