Part B Reason Code Crosswalk
Published 02/09/2018
Palmetto GBA is currently updating systems to incorporate the standardized CMS reason codes and statements. In the interim, please see below list of Palmetto GBA denial codes and the corresponding CMS reason codes and statements. For more information related to CMS reason codes, please refer to the CMS website at the following link.
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Part B Reason Code Crosswalk
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Palmetto GBA Reason Code
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Palmetto GBA Denial Code
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Palmetto GBA Granular Denial
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CMS (esMD) Reason Code
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CMS Reason Statement
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ALTered Medical Records
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ALTMR
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Original medical record has been altered.
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GBD13
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The documentation submitted contains cloned or altered information. Refer to Pub 100-8, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.5; Chapter 4.3
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Alternative Services were AVAilable and should have been utilized.
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ASAVA
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Alternative services were available and should have been utilized.
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GBC02
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The documentation submitted does not support medical necessity as listed in coverage requirement. Refer to SSA 1862, IOM, Medicare Program Integrity
Manual, Pub 100-08, Chapter 3, Section 3.6.2.2 |
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Transportation is only covered to the closest facility that can provide the necessary care.
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ATCCF
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Transportation is only covered to the closest facility that can provide the necessary care.
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GBB11
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The documentation submitted does not support the number of units billed. Refer to IOM, 100-08, Medicare Program Integrity Manual Chapter 3, Section 3.6.2.4 and Section 3.6.2.5, Medicare Claims Processing Manual Chapter 23
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Provider Indicated Claim Billed In Error
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BILER
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Claim billed in error per Provider.
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GBD01
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Billing Error. Refer to IOM, 100-08, Medicare Program Integrity Manual Chapter 3, Section 3.6.2.4; 100-04 Medicare Claims Processing Manual, Chapter 23
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GBD14
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The provider indicated services were billed in error. Refer to Section 1833 (e), Title XVIII, of the Social Security Act
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Lack or Absence of a Beneficiary Signature
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BNSIG
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Documentation received lacks the necessary beneficiary or authorized representative signature.
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GBF01
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The documentation submitted did not include a valid signature and/or credentials. Refer to IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3,
Section 3.3.2.4 and CFR Part 482.24 |
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No or partial documentation received
Example: 1. Chief Complaint Not DOocumented in the medical record. |
CCNDO
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Chief complaint not documented in the medical record.
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GBB01
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The requested records were not received. Refer to IOM, Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8
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GBB02
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The documentation submitted was incomplete and/or insufficient. Refer to IOM,Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8, B/C
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Another provider already reimbursed for services
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DNOTH
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Services deemed payable to another provider.
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GBA02
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This is a duplicate service previously submitted by a different provider. Refer to
IOM, Pub 100-04, Medicare Claims Processing Manual Chapter 1 section 120- 120.3 |
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Invalid signature
Example: 1. Documentation Not Signed by the Rendering Provider. |
DNSRP
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Documentation not signed by the rendering provider.
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GBD18
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The documentation submitted supports the performing and billing providers are
different. |
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Level of services billed were not documented; therefore, services DOWNCoded
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DOWNC
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Payer deems the information submitted does not support this level of service; downcoded.
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GBE01
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The documentation submitted does not support the medical necessity of the level
of service billed. Refer to IOM, 100-08, Medicare Program Integrity Manual Chapter 3, Section 3.6.2.4 and Section 3.6.2.5, Medicare Claims Processing Manual Chapter 23 |
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GBE02
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The documentation submitted does not support the level of service billed. Refer to IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.6.2.4
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No or partial documentation received
Examples: 1. E and M Components Not Met (example: billed 99214 and documentation did not meet 2 out of 3 criteria). |
EMCNM
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Evaluation and Management components not met.
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GBE01
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The documentation submitted does not support the medical necessity of the level
of service billed. Refer to IOM, 100-08, Medicare Program Integrity Manual Chapter 3, Section 3.6.2.4 and Section 3.6.2.5, Medicare Claims Processing Manual Chapter 23 |
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ILlegible DOCumentation
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ILDOC
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Information submitted deemed illegible.
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GBB10
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The documentation submitted is not legible. Refer to Medicare Program Integrity Manual, Chapter 3 Section 3.3.2.1
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INvalid provider Plan Of Care
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INPOC
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Documentation received contains an invalid/ incomplete provider plan of care.
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GBB02
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The documentation submitted was incomplete and/or insufficient. Refer to IOM,
Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8, B/C |
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Invalid physician certification statement
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INPSC
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Invalid physician certification statement.
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GBG01
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The documentation submitted did not include the required certifications or recertifications. Refer to Medicare Benefit Policy Manual, Chapter 15, 220.1.3
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Invalid SIGNature
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ISIGN
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Information submitted contains an invalid/illegible provider signature.
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GBF01
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The documentation submitted did not include a valid signature and/or credentials. Refer to IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3,
Section 3.3.2.4 and CFR Part 482.24 |
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GBF02
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The documentation submitted did not include a valid signature and a response to attestation or signature log request was not received. Refer to IOM, Medicare
Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.3.2.4 and CFR Part 482.24 |
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Invalid signature
Example: 1. NP/NPP signed but MD billed and "Incident To" Requirements Not Met. |
ITRNM
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NP/NPP signed but MD billed and "Incident To" requirements not met.
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GBD18
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The documentation submitted supports the performing and billing providers are
different. |
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NO Certificate of Medical Necessity received.
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NOCMN
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Documentation lacks the necessary Physician Certificate of Medical Necessity
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GBG01
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The documentation submitted did not include the required certifications or recertifications. Refer to Medicare Benefit Policy Manual, Chapter 15, 220.1.3
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NO CReDentials documented for provider
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NOCRD
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Provider signature does not include the necessary provider credentials.
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GBF01
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The documentation submitted did not include a valid signature and/or credentials.
Refer to IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.3.2.4 and CFR Part 482.24 |
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No Certification for therapy services
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NOCRT
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No certification for therapy services.
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GBG01
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The documentation submitted did not include the required certifications or recertifications. Refer to Medicare Benefit Policy Manual, Chapter 15, 220.1.3
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NO Chest X-Ray; no radiology report received
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NOCXR
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Documentation received lacks the necessary radiology report.
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GBB01
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The requested records were not received. Refer to IOM, Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8
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No or partial DOCumentation received
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NODOC
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Documentation requested for this date of service was not received or was incomplete.
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GBB02
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The documentation submitted was incomplete and/or insufficient. Refer to IOM,
Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8, B/C |
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NO ORDer
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NOORD
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Documentation lacks the necessary provider's order.
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GBB04
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The documentation submitted did not include a physician order. Refer to IOM, Pub 100-08, Chapter 3, Section 3.6.2.2
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NO POC for therapy services
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NOPOC
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Documentation received lacks the necessary provider plan of care.
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GBB02
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The documentation submitted was incomplete and/or insufficient. Refer to IOM,
Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8, B/C |
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No physician certification statement submitted in the medical record
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NOPSC
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No physician certification statement submitted in the medical record.
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GBG01
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The documentation submitted did not include the required certifications or
recertifications. Refer to Medicare Benefit Policy Manual, Chapter 15, 220.1.3 |
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NORSP
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Documentation not received timely.
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GBB01
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The requested records were not received. Refer to IOM, Pub 100-08, Medicare
Program Integrity Manual, Chapter 3, Section 3.2.3.8
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Missing or NO RUN report received
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NORUN
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Documentation received lacks the necessary Run Report
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GBB02
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The documentation submitted was incomplete and/or insufficient. Refer to IOM,
Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8, B/C |
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NO SIGnature on documentation/progress notes
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NOSIG
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Documentation lacks the necessary provider's signature.
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GBF01
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The documentation submitted did not include a valid signature and/or credentials.
Refer to IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.3.2.4 and CFR Part 482.24 |
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GBF02
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The documentation submitted did not include a valid signature and a response to
attestation or signature log request was not received. Refer to IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.3.2.4 and CFR Part 482.24 |
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No evidence of supervising therapist present
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NOSTP
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No evidence of supervising therapist present.
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GBD01
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Billing Error. Refer to IOM, 100-08, Medicare Program Integrity Manual Chapter
3, Section 3.6.2.4; 100-04 Medicare Claims Processing Manual, Chapter 23
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Documentation does NOT support Medical Necessity (when LCD is used)
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NOTML
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Per applicable LCD, payer deems the information submitted does not support medical necessity of services billed.
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GBC01
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The documentation submitted does not support medical necessity as listed in
coverage requirement. Refer to SSA 1862, IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.6.2.2 |
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Documentation does NOT support Medical Necessity (no LCD used)
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NOTMN
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Payer deems the information submitted does not support medical necessity of services billed.
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GBC02
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The documentation submitted does not support medical necessity. Refer to SSA
1862, IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.6.2.1, 3.6.2.2 |
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Documentation Submitted Lacks the Necessary Treatment Time Component
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NOTTM
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Documentation received lacks the necessary time component.
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GBB02
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The documentation submitted was incomplete and/or insufficient. Refer to IOM,
Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8, B/C |
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No Valid POC for therapy services
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NVPOC
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No valid plan of care for therapy services.
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GBB02
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The documentation submitted was incomplete and/or insufficient. Refer to IOM,
Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8, B/C |
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Order Not SIGned
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ONSIG
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Order lacks the necessary provider's signature.
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GBF01
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The documentation submitted did not include a valid signature and/or credentials.
Refer to IOM, Medicare Program Integrity Manual, Pub 100-08, Chapter 3, Section 3.3.2.4 and CFR Part 482.24 |
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ORiginal Document Not Received
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ORDNR
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Information received lacks the necessary patient medical record
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GBB01
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The requested records were not received. Refer to IOM, Pub 100-08, Medicare
Program Integrity Manual, Chapter 3, Section 3.2.3.8 |
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SIGnature STamp
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SIGST
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Documentation contains signature stamp.
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GBF03
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Stamped signatures are not accepted. Refer to IOM, Medicare Program Integrity
Manual, Pub 100-08, Chapter 3, Section 3.3.2.4 |
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Inconsistent information; WRONG patient or WRONG DOS.
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WRONG
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Documentation received contains incorrect/incomplete/invalid patient identification or date of service
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GBB06
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The documentation submitted was for the incorrect date of service. Refer to
Medicare Program Integrity Manual Chapter 3, Section 3.6.2.2 |
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GBB09
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The documentation submitted was for the incorrect beneficiary. Refer to IOM, Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8
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