CARC 181


Narrative: Procedure code was invalid on the date of service.

RARC M20

Narrative: Missing/incomplete/invalid HCPCS.

Reason for Non-Coverage
The procedure code billed is not valid for the date of service on the line of service or is not recognized by Medicare.

Claim Denial vs. Rejection: Rejection

Appeal Rights: No

Patient Responsibility: No

Reference and Educational Material

  • CMS IOM Publication 100-4, Chapter 26 (PDF, 605 KB), Section 10.1 and 10.4, SS 24D
  • CMS IOM Publication 100-4, Chapter 23 (PDF, 702 KB), Sec 30.2.2

Resolution
Verify the appropriate code that should be billed and if it is different from the previously billed code, submit a new claim with the correct code. For example, verify the MPFSDB status indicator of the procedure code to ensure that procedure is valid for Medicare purposes.





Last Updated: 04/02/2021