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Tuesday, September 6, 2016

Remark code N428, 5 and N425, CA96

Applicable ASC Messages for Certain Payment Indicators Effective for Services Performed on or after January 1, 2009 

Contractors shall deny services for HCPCS with payment indicators C5 (Inpatient surgical procedure under the OPPS; no payment made.), M6 (No payment made; paid under another fee schedule), U5 (Surgical unlisted service excluded from ASC payment. No payment made.), or X5 (Unsafe surgical procedure in ASC. No payment made. Use the following messages:

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

• RA Remark N428 - Service/procedure not covered when performed in this place of service.

• Claim Adjustment Reason Code 5 - The procedure code/bill type is inconsistent with place of service.




Contractors shall deny services for CPT codes with payment indicators E5 (Surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made.), or Y5 (Non-surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made.) and use the following messages:

• MSN 16.10 – Medicare does not pay for this item or service.

• Claim Adjustment Reason Code 96 – Non-covered charges.

• RA Remark Code - N425 - Statutorily excluded services.


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

NOTE: Contractors shall assign beneficiary liability for facility charges HCPCS codes billed with ASC payment indicators C5, E5, U5 and X5. 

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