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