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Jan 7, 2015. PR/177. This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements. If the patient did not have coverage on the date of service, you will also see this code. Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. No fee schedules, basic unit, relative values or related listings are included in CPT. Charges are reduced based on multiple surgery rules or concurrent anesthesia rules. OA Non-Covered; 1/5/2018 pdf-aboutus-plan . No fee schedules, basic unit, relative values or related listings are included in CPT. Payment denied because this provider has failed an aspect of a proficiency testing program. Claim/service denied. Secondary payment cannot be considered without the identity of or payment information from the primary payer. Charges exceed our fee schedule or maximum allowable amount. . Claim lacks date of patients most recent physician visit. Procedure/product not approved by the Food and Drug Administration. About Claim Adjustment Group Codes Maintenance Request Status Maintenance Request Form 11/16/2022 Filter by code: Reset Claim Adjustment Reason Codes (CARCs) communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. if, the patient has a secondary bill the secondary . At least one Remark . This (these) procedure(s) is (are) not covered. Adjustment to compensate for additional costs. LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright 2021, the American Hospital Association, Chicago, Illinois. 2023 Noridian Healthcare Solutions, LLC Terms & Privacy. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Claim denied as patient cannot be identified as our insured. Siemens has produced a new version to mitigate this vulnerability. Payment adjusted because charges have been paid by another payer. View the most common claim submission errors below. If you encounter this denial code, you'll want to review the diagnosis codes within the claim. This payment reflects the correct code. Screening Colonoscopy HCPCS Code G0105. Payment denied. Claim lacks the name, strength, or dosage of the drug furnished. 5. If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. CDT is a trademark of the ADA. Claim denied. The procedure code/bill type is inconsistent with the place of service. Claim/service denied. These are non-covered services because this is not deemed a medical necessity by the payer. 16: M20: WL5 Home Health Claim is missing the Core Based Statistical Area in the UB-04 Value Amount with UB-04 Value . 199 Revenue code and Procedure code do not match. Charges are covered under a capitation agreement/managed care plan. Unauthorized or illegal use of the computer system is prohibited and subject to criminal and civil penalties. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. Published 02/23/2023. Other Adjustments: This group code is used when no other group code applies to the adjustment. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. At any time, and for any lawful Government purpose, the government may monitor, record, and audit your system usage and/or intercept, search and seize any communication or data transiting or stored on this system. This is the standard format followed by all insurances for relieving the burden on the medical provider. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. Top Denial Reasons Cheat Sheet billed (generally means the individual staff person's qualifications do not meet requirements for that service). Missing/incomplete/invalid CLIA certification number. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Denial Code 185 defined as "The rendering provider is not eligible to perform the service billed". Service is not covered unless the beneficiary is classified as a high risk. Even if a provider has an individual NPI, it does not mean that his/her enrollment record is in PECOS and/or is active. You may also contact AHA at ub04@healthforum.com. Payment denied because only one visit or consultation per physician per day is covered. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. Claim Adjustment Reason Code (CARC) Claim adjustment reason codes explain financial adjustments. The claim/service has been transferred to the proper payer/processor for processing. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. var url = document.URL; End users do not act for or on behalf of the CMS. 2023 Noridian Healthcare Solutions, LLC Terms & Privacy. Claim/service denied. Your stop loss deductible has not been met. CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). Users must adhere to CMS Information Security Policies, Standards, and Procedures. Last Updated Mon, 30 Aug 2021 18:01:22 +0000. The referring/prescribing provider is not eligible to refer/prescribe/order/perform the service billed. Valid group codes for use on Medicare remittance advice: These Group Codes are combined with Claim Adjustment Reason Codes that can be numeric or alpha-numeric, ranging from 1 to W2. Claim/service not covered by this payer/processor. Successful exploitation of these vulnerabilities may allow an attacker to cause a denial-of-service condition or remotely exploit arbitrary code. Claim/service denied. The responsibility for the content of this file/product is with Noridian Healthcare Solutions or the CMS and no endorsement by the AMA is intended or implied. Illustration by Lou Reade. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes. Same as denial code - 11, but here check which DX code submitted is incompatible with provider type. 16 Claim/service lacks information which is needed for adjudication. 4. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. 073. Do not use this code for claims attachment(s)/other documentation. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. The delay or denial of any such licence will not be grounds for the Buyer to cancel any purchase. CO/96/N216. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. Vladimir Dashchenko and Sergey Temnikov from Kaspersky Labs reported this issue directly to Siemens. In this blog post, you will learn how to use the Snyk API to retrieve all the issues associated with a given project. Please click here to see all U.S. Government Rights Provisions. PR 96 DENIAL CODE: PATIENT RELATED CONCERNS When a patient meets and undergoes treatment from an Out-of-Network provider. Medicare denial codes are standard messages used to provide or describe the information to a medical patient or provider by insurances about why a claim was denied. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. . If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Oxygen equipment has exceeded the number of approved paid rentals. We are a medical billing company that offers Medical Billing Services and support physicians, hospitals,medical institutions and group practices with our end to end medical billing solutions 160 11/11/2013 1 Denial Codes Found on Explanations of Payment/Remittance Advice (EOPs/RA) Denial Code Description Denial Language 1 Services after auth end The services were provided after the authorization was effective and are not covered benefits under this plan. Select the Reason or Remark code link below to review supplier solutions to the denial and/or how to avoid the same denial in the future. If so read About Claim Adjustment Group Codes below. Claim/service lacks information or has submission/billing error(s). There should be other codes on the remit, especially if it was Medicare, like a CO or PR or OA code as well that should give the actual claim denial reason. Patient is covered by a managed care plan. 4) Some deny EX Codes have an equivalent Adjustment Reason Code, but do not have a RA Remark Code. Payment is included in the allowance for another service/procedure. Denial Code 119 defined as "Benefit maximum for this time period or occurrence has been reached". (Check PTAN was effective for the DOS billed or not), This denial is same as denial code - 15, please refer and ask the question as required. Interim bills cannot be processed. The use of the information system establishes user's consent to any and all monitoring and recording of their activities. Plan procedures of a prior payer were not followed. Duplicate claim has already been submitted and processed. PR - Patient Responsibility denial code list MCR - 835 Denial Code List PR - Patient Responsibility - We could bill the patient for this denial however please make sure that any other rejection reason not specified in the EOB. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Although the IG allows up to 5 remark codes to be reported in the MOA/MIA segment and up to 99 remark codes in the LQ segment, system limitation may restrict how many codes MACs can actually report. Incentive adjustment, e.g., preferred product/service. The procedure/revenue code is inconsistent with the patients age. Siemens has identified a resource exhaustion vulnerability that causes a denial-of-service condition in the Siemens SCALANCE S613 device. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice . Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. The following information affects providers billing the 11X bill type in . The scope of this license is determined by the ADA, the copyright holder. The date of birth follows the date of service. Denial Code 16: The service performed is not a covered benefit o The provider should verify that the service is covered for the . 64 Denial reversed per Medical Review. CPT is a trademark of the AMA. A16(27) (2001) 1761-1773 July 20, 2001 arXiv:hep-th/0107167 This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier, Misrouted claim. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). var url = document.URL; 2. Most often this kind of billing is done for those items which can be covered by the patient easily and the list is given before any kind of coverage is issued. Applications are available at the AMA Web site, https://www.ama-assn.org. Denial Code - 18 described as "Duplicate Claim/ Service". 16 Claim/service lacks information which is needed for adjudication. The scope of this license is determined by the AMA, the copyright holder. Claim/Service denied. Claim Denial Codes List. Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. (Use only with Group Code PR). same procedure Code. Billing/Reimbursement Medicare denial code PR-177 coder.rosebrum@yahoo.com Jul 12, 2021 C coder.rosebrum@yahoo.com New Messages 2 Location Freeman, WV Best answers 0 Jul 12, 2021 #1 Patient's visit denied by MCR for "PR-177: Patient has not met the required eligibility requirements". To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. Patient payment option/election not in effect. End users do not act for or on behalf of the CMS. and PR 96(Under patients plan). Check to see the procedure code billed on the DOS is valid or not? 16 Claim/service lacks information which is needed for adjudication. Receive Medicare's "Latest Updates" each week. 2 Coinsurance Amount. Step #2 - Have the Claim Number - Remember . LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) Denial Code described as "Claim/service not covered by this payer/contractor. PR - Patient Responsibility: This group code is used when the adjustment represents an amount that may be billed to the patient or insured. Claim/service denied. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Charges exceed your contracted/legislated fee arrangement. Check eligibility to find out the correct ID# or name. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes. PR - Patient Responsibility: . The M16 should've been just a remark code. The use of the information system establishes user's consent to any and all monitoring and recording of their activities. Denial Code - 146 described as "Diagnosis was invalid for the DOS reported". Services by an immediate relative or a member of the same household are not covered. Charges for outpatient services with this proximity to inpatient services are not covered. Procedure code was incorrect. 3. The ADA is a third-party beneficiary to this Agreement. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Denial Code - 140 defined as "Patient/Insured health identification number and name do not match". PR 1 Denial Code - Deductible Amount; CO 4 Denial Code - The procedure code is inconsistent with the modifier used or a required modifier is missing; . These are non-covered services because this is not deemed a 'medical necessity' by the payer. These generic statements encompass common statements currently in use that have been leveraged from existing statements. 4. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. M127, 596, 287, 95. This (these) service(s) is (are) not covered. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. 107 or in any way to diminish . Based on Provider's consent bill patient either for the whole billed amount or the carrier's allowable. Prior hospitalization or 30 day transfer requirement not met. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Claim lacks individual lab codes included in the test. Usage: . Note: The information obtained from this Noridian website application is as current as possible. PR Patient Responsibility. Check to see, if patient enrolled in a hospice or not at the time of service. Claim/service denied. Charges reduced for ESRD network support. 3. Same as denial code - 11, but here check which dx code submitted is incompatible with patient's age, Ask the same questions as denial code 11, but here check which DX code submitted is incompatible with patient's gender. PR 85 Interest amount. Applications are available at the AMA Web site, https://www.ama-assn.org. The most critical one is CVE-2022-4379, a use-after-free vulnerability discovered in the NFSD implementation that could allow a remote attacker to cause a denial of service (system crash) or execute arbitrary code. . CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). Reason codes, and the text messages that define those codes, are used to explain why a . Claim/service lacks information or has submission/billing error(s). 1) Get the denial date and the procedure code its denied? No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. 2. VAT Status: 20 {label_lcf_reserve}: . PR THE DIAGNOSIS AND/OR HCPCS USED WITH REVENUE CODE 0923 ARE NOT PAYABLE FOR THIS PR YOUR PATIENT'S BLUES PLAN ASKED FOR THE EOMB AND MEDICAL RECORDS FOR THIS SERVICE PLEASE FAX THEM TO US AT 248-448-5425 OR 248-448-5014 OR SEND TO MAIL CODE B552, BCBSM 600 E. LAFAYETTE, DETROIT MI 48226. Provider promotional discount (e.g., Senior citizen discount). Discount agreed to in Preferred Provider contract. Newborns services are covered in the mothers allowance. Account Number: 50237698 . Partial Payment/Denial - Payment was either reduced or denied in order to Only SED services are valid for Healthy Families aid code. 1. LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright 2021, the American Hospital Association, Chicago, Illinois. Reason Code 16 | Remark Codes MA13 N265 N276 Common Reasons for Denial Item (s) billed did not have a valid ordering physician National Provider Identifier (NPI) registered in Medicare Provider Enrollment, Chain and Ownership System (PECOS) Next Step Resubmit claim with a valid ordering physician NPI registered in PECOS How to Avoid Future Denials This updated advisory is a follow-up to the original advisory titled ICSA-16-336-01 Siemens SICAM PAS Vulnerabilities that was published December 1, 2016, on the NCCIC/ICS-CERT web site. Patient will considered new if the doctor never treat him in the past two year otherwise he should be billed as Established patient. Payment denied. 4. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing. PR 27 denial code description - expenses incurred after patient's insurance coverage terminated. Coinsurance: Percentage or amount defined in the insurance plan for which the patient is responsible. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Additional information is supplied using remittance advice remarks codes whenever appropriate. You must send the claim/service to the correct carrier". least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) The CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. Beneficiary was inpatient on date of service billed, HCPCScode billed is included in the payment/allowance for another service/procedure that has already been adjudicated. CMS DISCLAIMER. Payment adjusted because coverage/program guidelines were not met or were exceeded. pi old reason code new group code new reason code 204 co 139 204 pr b5 204 pr b8 204 pr 227 n102 204 pr 227 n102 pi 125 m49, ma92 204 pi 5 204 pi 7 204 pr b7 204 pi 6 204 pi 16 204 pi 4 49 35 pr pr 49 119 10 pi 7 9 pi 9 b7 pr 111 16 16 old remark codes m49, m56 ma06, n318 pi 125 new remark codes m54 n318 . Denial Code 16 described as "Claim/service lacks information or has submission/billing error(s) which is required for adjudication". Denial Codes in Medical Billing - Lists: CO - Contractual Obligations OA - Other Adjsutments PI - Payer Initiated reductions PR - Patient Responsibility Let us see some of the important denial codes in medical billing with solutions: Show Showing 1 to 50 of 50 entries Previous Next Timely Filing Limit of Insurances This vulnerability could be exploited remotely. Subscriber is employed by the provider of the services. There are times in which the various content contributor primary resources are not synchronized or updated on the same time interval. Plan procedures not followed. Non-covered charge(s). We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. Payment denied. 66 Blood deductible. Ask the same questions as denial code - 5, but here need check which procedure code submitted is incompatible with patient's age? PR 96 Denial code means non-covered charges. o The provider should verify place of service is appropriate for services rendered. Patient cannot be identified as our insured. Increased Acceptance of RPM Remote patient monitoring is a form On November 2, 2021, the Centers for Medicare and Medicaid Beginning January 1, 2022, psychologists and other health care providers cms mental health services billing guide 2019, coding and payment guide for behavioral health services 2019, Coding Guidelines for Coronavirus for Medicare Beneficiaries, cpt code 90791 documentation requirements, cpt codes for psychiatric nurse practitioners, evaluation and management of a new patient, Information about billing for coronavirus, Information about billing for coronavirus (COVID-19), telemedicine strategies for novel corona virus, Billing for Remote Patient Monitoring (RPM), No Surprises in 2022 due to No Surprises Act (NSA). No fee schedules, basic unit, relative values or related listings are included in CDT. Group Codes CO = Contractual Obligations CR = Corrections and Reversal OA = Other Adjustments PI = Payer Initiated Reductions PR = Patient Responsibility Claim/service denied. An attachment/other documentation is required to adjudicate this claim/service. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. CO Contractual Obligations 2 Services prior to auth start The services were provided before the authorization was effective and are not covered benefits under this Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. An LCD provides a guide to assist in determining whether a particular item or service is covered. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Samoa, Guam, N. Mariana Is., AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY, Last Updated Tue, 28 Feb 2023 16:05:45 +0000. This provider was not certified/eligible to be paid for this procedure/service on this date of service. 0. (For example: Supplies and/or accessories are not covered if the main equipment is denied). There are several reasons you may find it valuable, notably pulling them into your reports and dashboards, giving management and developers visibility into their vulnerability status within the portals and workflows they're already using. Workers Compensation State Fee Schedule Adjustment. The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes. The beneficiary is not liable for more than the charge limit for the basic procedure/test. Payment adjusted as procedure postponed or cancelled. Do not use this code for claims attachment(s)/other documentation. Reproduced with permission. You must send the claim to the correct payer/contractor. CMS Disclaimer This license will terminate upon notice to you if you violate the terms of this license. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Denial Code 22 described as "This services may be covered by another insurance as per COB". Denial code - 11 described as the "Dx Code is in-consistent with the Px code billed". AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. Our records indicate that this dependent is not an eligible dependent as defined. Missing/incomplete/invalid initial treatment date. Documentation requested was not received or was not received timely, Item billed may require a specific diagnosis or modifier code based on related Local Coverage Determination (LCD). It may help to contact the payer to determine which code they're saying is not covered, if you submitted multiple diagnosis codes. 16. Missing/incomplete/invalid ordering provider name. B. Services not provided or authorized by designated (network) providers. Therapeutic Behavioral Service valid only with a Full Scope Aid Code and an EPSDT Aid Code. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. The AMA does not directly or indirectly practice medicine or dispense medical services. PI Payer Initiated reductions Remark codes that apply to an entire claim must be reported in either an ASC X12 835 MIA (inpatient) or MOA (non-inpatient) segment, as applicable. A Search Box will be displayed in the upper right of the screen. Resubmit claim with a valid ordering physician NPI registered in PECOS. Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this days supply. E2E Medical Billing Servicescan assist you in addressing these denials and recover the insurance reimbursement. This (these) diagnosis(es) is (are) not covered, missing, or are invalid. These could include deductibles, copays, coinsurance amounts along with certain denials. This denial code generally occurs when the diagnosis is inconsistent with the procedure as long as the procedure code shows an inappropriate diagnostic code. October - December 2022, Inpatient Hospital and Psych Medical Review Top Denial Reason Codes. Express-Scripts, Inc. Stateside: 1-877-363-1303 Overseas: 1-866-275-4732 (where toll-free service is established) Express Scripts Website Services denied at the time authorization/pre-certification was requested. Refer to the 835 Healthcare Policy Identification Segment (loop Denial Code 54 described as "Multiple Physicians/assistants are not covered in this case". Same denial code can be adjustment as well as patient responsibility. The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. No appeal right except duplicate claim/service issue. Medicare Claim PPS Capital Cost Outlier Amount. Users must adhere to CMS Information Security Policies, Standards, and Procedures. Coverage not in effect at the time the service was provided, Pre-Certification or Authorization absent, Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. At any time, and for any lawful Government purpose, the government may monitor, record, and audit your system usage and/or intercept, search and seize any communication or data transiting or stored on this system. ex58 16 m49 deny: code replaced based on code editing software recommendation deny ex59 45 pay: charges are reduced based on multiple surgery rules pay .