June 11, 2004

CMS

Remittance Advice Remark Code and Claim Adjustment Reason Code Update

Effective Date: July 1, 2004
Implementation Date: July 6, 2004

The Centers for Medicare & Medicaid Services (CMS) maintains the remittance advice remark code list, one of the code lists mentioned in the ASC X12 transaction 835 (Health Care Claim Payment/Advice) version 4010A1 Implementation Guide (IG). The complete list of these codes may be found at: http://www.wpc-edi.com/codes/Codes.asp. The list is updated three times per year.

By July 6, 2004 all Medicare carriers and fiscal intermediaries (FIs) will have incorporated all current remark code changes in their Medicare systems.

The following table summarizes remark code changes made from November 1, 2003 to February 29, 2004.

	New Codes
	N213	Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
	N214	Missing/incomplete/invalid history or history of the related initial surgical procedure(s).
	‡ N215	A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own determination.
	‡ N216	Patient is not enrolled in this portion of our benefit package.
	M119	Missing/incomplete/invalid/deactivated/withdrawn National Drug Code.

	Modified Remark Codes (Effective 04/01/2004)
	‡ N115	This decision is based on a Local Medical Review Policy (LMRP) or Local Coverage Determination (LCD). An LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at: http://www.cms.hhs.gov/mcd, or if you do not have Web access, you may contact the contractor to request a copy of the LMRP/LCD.

	Modified Remark Codes (Effective 02/01/2004)
	‡ M51	Missing/incomplete/invalid procedure code(s) and/or dates.
	‡ M69	Paid at the regular rate because you did not submit documentation to justify the modified procedure code.
	MA53	Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
	MA92	Missing/incomplete/invalid plan information for other insurance.

	Deactivated Remark Codes
		None
	Note: ‡ codes are those likely to be seen on LAB claims.

Reference "Medlearn Matters...Information for Medicare Providers": MM3227.

Related Change Request (CR) #: 3227
Related CR Transmittal #: 154

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