Tag Archives: Medicare EOB reason codes

Medicare denial B10 CO 109, CO 150 codes

CO Contraçtual Obligation. Amount for which the not be billed for this amount. The difference between billed amount and allowed amount. It should be written off. Patient responsibility. Amount that may be billed to a patient another payer Usually deductible and coins. Bill patient or secondary if patient has. B10 Allowed amount has been reduced [...]

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 [...]

Medicare denial CO – 4, CO 5 , CO – 20 & 21 and CO 29

CO – 4 The procedure code is inconsistent with the modifier used, or a required modifier is missing. Check the Modifier and use the correct modifier or Add the Modifier. For example some lab codes requires QW modifier. CO 5 The procedure code/bill type is inconsistent with the place of service. Check the POS and [...]

Medicare denial co 31 & 140 , co 38 , co 62 and co 63

CO 31 & 140 Patient cannot be identified as our insured. Patient/Insured health identification number and name do not match. Check the patient details including patient name, id and DOB. Correct it and resubmit the claims. CO 38 Services not provided or authorized by designated (network/primary care) providers. Check the CPT which was submitted. If [...]

Medicare rejection CO 26, 27 , 28 and CO 30 ,177 , 178, 180

co 26 , 27 & 28 Expenses incurred prior to coverage. Expenses incurred after coverage terminated. Coverage not in effect at the time the service was provided. Check the eligibility through IVR and call patient for any other insurance information. If patient hasn’t have any insurance. Bill patient. CO 30, 177, 178 and 180 Payment [...]

denial code B9 B14 B16 & D18 D21

B9 Patient is enrolled in a Hospice. Bill with modifier QW or QV. Please see the below link for more information. http://billingatchennai.blogspot.com/2008/09/medicare-denial-and-action-enrolled-in.html B14 Only one visit or consultation per physician per day is covered. We cant bill the two consult visit on same day. Check your superbill and correct the information. B16 ‘New Patient’ qualifications [...]