Monday, May 23, 2016

CARC 188, MSN 21.8 - Medicare Summary Notices (MSN), Reason Codes, and Remark Codes

When denying MRI line items on institutional claims when billed with the appropriate MRI code and modifier KX is not present, use the following messages:

If ICD-9-CM is applicable, ICD-9 code V45.01

If ICD-10-CM is applicable, ICD-10 code Z95.0

• CARC 188 – This product/procedure is only covered when used according to the FDA recommendations

• MSN 21.8 – Services performed using equipment that has not been approved by the Food and Drug Administration are not covered. Spanish Version - “Servicios rendidos usando equipo que no es aprobado por la Administraci√≥n de Alimentos y Drogas no son cubiertos”.

When denying MRI line items on professional claims and modifier KX is not present, use the following messages:

If ICD-9-CM is applicable, ICD-9 code V45.01

If ICD-10-CM is applicable, ICD-10 code Z95.0

• CARC 188 - This product/procedure is only covered when used according to the FDA recommendations

• MSN 21.8 - Services performed using equipment that has not been approved by the Food and Drug Administration are not covered
When denying MRI line items that do not include all of the following line items:

• An appropriate MRI code,

• If ICD-9-CM is applicable, ICD-9 code V45.02 (automatic implantable cardiac defibrillator) or ICD-9 code V45.01 (cardiac pacemaker),

• ICD-10-CM is applicable, ICD-10 code Z95.810 (automatic implantable cardiac defibrillator)or ICD-10 code Z95.0 (cardiac pacemaker),

• Modifier Q0,

• If ICD-9-CM is applicable, ICD-9 code V70.7 Examination of participant in clinical trial (for institutional claims only)or

• If ICD-10-CM is applicable, ICD-10 code Z00.6 – Examination of participant in clinical trial (for institutional claims only), and

• Condition code 30 (for institutional claims only), use the following messages:

o CARC B5 - Coverage/program guidelines were not met or exceeded

o 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.

o 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.

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