Medicaid Claim Denial Codes - 4
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.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D10 Claim/service denied. Completed physician financial relationship form not on file.
Note: Inactive for 003070, since 8/97. Use code 17.
D11 Claim lacks completed pacemaker registration form.
Note: Inactive for 003070, since 8/97. Use code 17.
D12 Claim/service denied. Claim does not identify who performed the purchased diagnostic
test or the amount you were charged for the test.
Note: Inactive for 003070, since 8/97. Use code 17.
D13 Claim/service denied. Performed by a facility/supplier in which the ordering/referring
physician has a financial interest.
Note: Inactive for 003070, since 8/97. Use code 17.
D14 Claim lacks indication that plan of treatment is on file.
Note: Inactive for 003070, since 8/97. Use code 17.
D15 Claim lacks indication that service was supervised or evaluated by a physician.
Note: Inactive for 003070, since 8/97. Use code 17.
D16 Claim lacks prior payer payment information.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [N4].
D17 Claim/Service has invalid non-covered days.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [M32, M33].
D18 Claim/Service has missing diagnosis information.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [MA63, MA65].
D19 Claim/Service lacks Physician/Operative or other supporting documentation
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [M29, M30, M35, M66].
D20 Claim/Service missing service/product information.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [M20, M67, M19, MA67].
D21 This (these) diagnosis(es) is (are) missing or are invalid
Note: New as of 6/05
W1 Workers Compensation State Fee Schedule Adjustment
Note: New as of 2/00
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.
Note: Inactive for 004010, since 2/99. Use code 16 and remark codes if necessary.
D10 Claim/service denied. Completed physician financial relationship form not on file.
Note: Inactive for 003070, since 8/97. Use code 17.
D11 Claim lacks completed pacemaker registration form.
Note: Inactive for 003070, since 8/97. Use code 17.
D12 Claim/service denied. Claim does not identify who performed the purchased diagnostic
test or the amount you were charged for the test.
Note: Inactive for 003070, since 8/97. Use code 17.
D13 Claim/service denied. Performed by a facility/supplier in which the ordering/referring
physician has a financial interest.
Note: Inactive for 003070, since 8/97. Use code 17.
D14 Claim lacks indication that plan of treatment is on file.
Note: Inactive for 003070, since 8/97. Use code 17.
D15 Claim lacks indication that service was supervised or evaluated by a physician.
Note: Inactive for 003070, since 8/97. Use code 17.
D16 Claim lacks prior payer payment information.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [N4].
D17 Claim/Service has invalid non-covered days.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [M32, M33].
D18 Claim/Service has missing diagnosis information.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [MA63, MA65].
D19 Claim/Service lacks Physician/Operative or other supporting documentation
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [M29, M30, M35, M66].
D20 Claim/Service missing service/product information.
Note: Inactive as of version 5010. Use code 16 with appropriate claim payment
remark code [M20, M67, M19, MA67].
D21 This (these) diagnosis(es) is (are) missing or are invalid
Note: New as of 6/05
W1 Workers Compensation State Fee Schedule Adjustment
Note: New as of 2/00
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