Thursday, September 1, 2016

ASC denial - N200, M97 AND M15

Contractors shall deny globally billed ancillary services on the ASCFS list if billed by specialties other than 49 provided in an ASC setting (POS 24) and use the following messages: 

• MSN 16.2 – This service cannot be paid when provided in this location/facility.

• N200 – The professional component must be billed separately

• Claim Adjustment Reason Code 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing. Note Refer to the 835 healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

Contractors shall deny separately billed implantable devices using the following messages: 
• MSN 16.32 – Medicare does not pay separately for this service.

• RA Remark Code M97 - Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.

• RA Remark Code M15 - Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed;

• RA Remark Code MA 109 - Claim processed in accordance with ambulatory surgical guidelines.

• RA Remark Code M16 - Please see our Web site, mailings or bulletins for more details concerning this policy/procedure/decision.(contractor discretion)

If there is a related, approved surgical procedure for the billing ASC for the same date of service, also include the following message:

• MSN 16.8 - Payment is included in another service received on the same day.

No comments:

Post a Comment

Popular Posts