pi 16 denial code descriptions

B8 Alternative services were available, and should have been utilized. The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes. Missing/incomplete/invalid ordering provider primary identifier. 52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. 11 The diagnosis is inconsistent with the procedure. 214 Workers Compensation claim adjudicated as non-compensable. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. 159 Service/procedure was provided as a result of terrorism. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. 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. A copy of this policy is available on the. 144 Incentive adjustment, e.g. Denial codes are codes assigned by health care insurance companies to faulty insurance claims. The AMA does not directly or indirectly practice medicine or dispense medical services. 174 Service was not prescribed prior to delivery. Common Reasons for Denial This claim appears to be covered by a primary payer. There is a date span overlap or overutilization based on related LCD, Item billed is same or similar to an item already received in beneficiary's history, An initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) was not submitted with claim or on file with Noridian, Prescription is not on file or is incomplete or invalid, Recertified or revised Certificate of Medical Necessity (CMN) or DME Information Form (DIF) for item was not submitted or not on file with Noridian, Procedure code was invalid on the date of service, Precertification/authorization/notification/pre-treatment absent, Item billed is included in allowance of other service provided on the same date, Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services, Resubmit a new claim with the requested information, Oxygen equipment has exceeded number of approved paid rentals. Procedure code missing from bill. 180 Patient has not met the required residency requirements. 128 Newborn's services are covered in the mother's allowance. CPT is a trademark of the AMA. 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. 212 Administrative surcharges are not covered. if(pathArray[4]){document.getElementById("usprov").href="/web/"+pathArray[4]+"/help/us-government-rights";} 15 The authorization number is missing, invalid, or does not apply to the billed services or provider. 191 Not a work related injury/illness and thus not the liability of the workers compensation carrier. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. 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. *The description you are suggesting for a new code or to replace the description for a current code. Medicare does not pay for this service/equipment/drug. Performed by a facility/supplier in which the ordering/referring physician has a financial interest. Denial code 50 defined as "These are non covered services because this is not deemed a medical necessity by the payer". W2 Payment reduced or denied based on workers compensation jurisdictional regulations or payment policies, use only if no other code is applicable. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. This license will terminate upon notice to you if you violate the terms of this license. Denial Code CO 16 lacks information Remark Codes - Billing Executive When a CO16 rejection is issued, the first step is to examine any associated remark codes. 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. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) Ask the same questions with representative as denial code - 5, but here check which procedure code submitted is incompatible with patient's gender. P19 Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. Denial code - 97 described when "The benefit for this service is included in the payment or allowance for another service/procedure that has already been adjudicated". Warning: you are accessing an information system that may be a U.S. Government information system. A4 Medicare Claim PPS Capital Day Outlier Amount. 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. Determine why main procedure was denied or returned as unprocessable and correct as needed. The AMA does not directly or indirectly practice medicine or dispense medical services. B13 Previously paid. 232 Institutional Transfer Amount. They include reason and remark codes that outline reasons for not covering patients' treatment costs. The qualifying other service/procedure has not been received/adjudicated. This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Additional information will be sent following the conclusion of litigation. 46 This (these) service(s) is (are) not covered. PR 166 These services were submitted after this payers responsibility for processing claims under this plan ended. P22 Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. 140 Patient/Insured health identification number and name do not match. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test. P20 Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only. This decision was based on a Local Coverage Determination (LCD). 199 Revenue code and Procedure code do not match. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Benefits are not available under this dental plan. PR 27 Expenses incurred after coverage terminated. Based on payer reasonable and customary fees. Applications are available at the American Dental Association web site, http://www.ADA.org. 201 Workers Compensation case settled. 3. This is the standard form that all insurances follow to ease the burden on medical providers. D16 Claim lacks prior payer payment information. View the most common claim submission errors below. NULL CO 16, A1 MA66 044 Denied. 4. To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. Last Updated Wed, 26 Apr 2023 17:14:52 +0000. Identity verification required for processing this and future claims. 78 Non-Covered days/Room charge adjustment. 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. 107 The related or qualifying claim/service was not identified on this claim. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. PR 34 Claim denied. All rights reserved. These are non-covered services because this is not deemed a 'medical necessity' by the payer. 141 Claim spans eligible and ineligible periods of coverage. 24 Charges are covered under a capitation agreement/managed care plan. 31 Patient cannot be identified as our insured. B21 The charges were reduced because the service/care was partially furnished by anotherphysician. 132 Prearranged demonstration project adjustment. Separate payment is not allowed. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. This system is provided for Government authorized use only. Your Stop loss deductible has not been met. 154 Payer deems the information submitted does not support this days supply. No maximum allowable defined bylegislated fee arrangement. Receive Medicare's "Latest Updates" each week. 49 This is a non-covered service because it is a routine/preventive exam or a diagnostic/screeningprocedure done in conjunction with a routine/preventive exam. 171 Payment is denied when performed/billed by this type of provider in this type of facility. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. This system is provided for Government authorized use only. 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. 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. Procedure/service was partially or fully furnished by another provider. 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. Non-covered charge(s). 42 Charges exceed our fee schedule or maximum allowable amount. Samoa, Guam, N. Mariana Is., AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY. pi 16 denial code descriptions HIPAA-AS requirements do not permit payers to display proprietary codes (internal reason, adjustment and denial codes) on the 835 ERA. B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. 231 Mutually exclusive procedures cannot be done in the same day/setting. 222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. B14 Only one visit or consultation per physician per day is covered. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose. Denial Code Resolution / Reason Code 16 | Remark Codes MA13 N265 N276 Share 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 59 Processed based on multiple or concurrent procedure rules. 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. All Rights Reserved. Did not indicate whether we are the primary or secondary payer. 163 Attachment/other documentation referenced on the claim was not received. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. PR 1 Deductible Amount Members plan deductible applied to the allowable benefit for the rendered service(s). Please any help I can get! 178 Patient has not met the required spend down requirements. Report Type Codes. The referring provider identifier is missing, incomplete or invalid, Duplicate claim has already been submitted and processed, This claim appears to be covered by a primary payer. Out of state travel expenses incurred prior to 7-1-91 Patient cannot be identified as our insured. The use of the information system establishes user's consent to any and all monitoring and recording of their activities. 99 Medicare Secondary Payer Adjustment Amount. All rights reserved. P14 The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Patient cannot be identified as our insured. 236 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. 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. 1.3 7/16/2020 Updates to multiple sections based on revised terminology and process changes . No fee schedules, basic unit, relative values or related listings are included in CDT. if the claim is denied as Coding guidelines(LCD/NCD) not met. 116 The advance indemnification notice signed by the patient did not comply with 117 Transportation is only covered to the closest facility that can provide the necessary care. 205 Pharmacy discount card processing fee. 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. Jun 15, 2018 Applicable federal, state or local authority may cover the claim/service. The primary payer information was either not reported or was illegible Next Step Correct claim and resubmit as a new claim How to Avoid Future Denials Always verify eligibility and ask the Medicare Secondary Payer Questions 190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Save my name, email, and website in this browser for the next time I comment. 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. 183 The referring provider is not eligible to refer the service billed. 2023 Noridian Healthcare Solutions, LLC Terms & Privacy. Medical Billing Denial Codes are standard letters used to provide or describe the information to a patient or medical provider for why an insurance company is denying a claim. No fee schedules, basic unit, relative values or related listings are included in CPT. A6 Prior hospitalization or 30 day transfer requirement not met. 250 The attachment/other documentation content received is inconsistent with the expected content. var url = document.URL; Therefore, you have no reasonable expectation of privacy. FOURTH EDITION. 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. 3. 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. P12 Workers compensation jurisdictional fee schedule adjustment. 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. 121 Indemnification adjustment compensation for outstanding member responsibility. 38 Services not provided or authorized by designated (network/primary care) providers. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. Code Description 127 Coinsurance - Major Medical. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. Charges are covered under a capitation agreement/managed care plan. The ADA is a third-party beneficiary to this Agreement. End Users do not act for or on behalf of the CMS. D15 Claim lacks indication that service was supervised or evaluated by a physician. To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. P4 Workers Compensation claim adjudicated as non-compensable. PR B9 Services not covered because the patient is enrolled in a Hospice. 164 Attachment/other documentation referenced on the claim was not received in a timely fashion. Do you have any other denial codes on these codes like an M or N denial reason. This care may be covered by another payer per coordination of benefits. B18 This procedure code and modifier were invalid on the date of service. 5. Do not use this code for claims attachment(s)/other documentation. D10 Claim/service denied. Receive Medicare's "Latest Updates" each week. 142 Monthly Medicaid patient liability amount. B17 Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current. 61 Penalty for failure to obtain second surgical opinion. D1 Claim/service denied. 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. Payment was made for this claim conditionally because an HHA episode of care has been filed for this patient. 167 This (these) diagnosis(es) is (are) not covered. Note: The information obtained from this Noridian website application is as current as possible. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). Any questions pertaining to the license or use of the CPT must be addressed to the AMA. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Usually these denials help tell the "denial" story a . These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). 157 Service/procedure was provided as a result of an act of war. To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. The scope of this license is determined by the ADA, the copyright holder. Missing/incomplete/invalid credentialing data. 137 Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Claim/service lacks information or has submission/billing error(s). 188 This product/procedure is only covered when used according to FDA recommendations. 30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. 208 National Provider Identifier Not matched. 106 Patient payment option/election not in effect. 70 Cost outlier Adjustment to compensate for additional costs. No appeal right except duplicate claim/service issue. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes. PR 201 Workers Compensation case settled. This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier, Misrouted claim. PI: Payor Initiated Reduction Start: 05/20/2018: PR: Patient Responsibility Start: 05/20/2018: Products. NULL CO A1, 45 N54, M62 . Please click here to see all U.S. Government Rights Provisions. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. Did you receive a code from a health plan, such as: PR32 or CO286? You may also contact AHA at ub04@healthforum.com. Verify that ordering physician NPI is on list of physicians and other non-physician practitioners enrolled in PECOS. W7 Procedure is not listed in the jurisdiction fee schedule. 12 The diagnosis is inconsistent with the provider type. FOURTH EDITION. Receive Medicare's "Latest Updates" each week. 193 Original payment decision is being maintained. Patient is responsible for amount of thisclaim/service through WC Medicare set aside arrangement or other agreement. 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. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. B23 Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. PR 168 Payment denied as Service(s) have been considered under the patients medical plan. PR - Patient Responsibility denial code list, PR 1 Deductible Amount PR 2 Coinsurance Amount PR 3 Co-payment Amount PR 204 This service/equipment/drug is not covered under the patient's current benefit plan PR B1 Non-covered visits. 23 The impact of prior payer(s) adjudication including payments and/or adjustments. 255 The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. 22 This care may be covered by another payer per coordination of benefits. 2023 Noridian Healthcare Solutions, LLC Terms & Privacy. Please click here to see all U.S. Government Rights Provisions. No fee schedules, basic unit, relative values or related listings are included in CDT. 57 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. Here you could find Group code and denial reason too. PR Patient Responsibility. Jan 7, 2020 . For example PR 45, We could bill patient but for CO 45, its a adjustment and we cant bill the patient. 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. Patient is enrolled in a hospice program. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. This Payer not liable for claim or service/treatment. Action for PR 236 If the service was already been paid as part of another service billed for the same date of service.Check Points:The service which was billed is not compatible with another procedureCheck if we billed the same procedure twice with out modifierCheck the units which was billedCheck all the above and append with appropriate modifier, resubmit the claim as Corrected Claim. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. else{document.getElementById("usprov").href="/web/"+"jeb"+"/help/us-government-rights";}, Advance Beneficiary Notice of Noncoverage (ABN), Oral Anticancer Drugs and Oral Antiemetic Drugs, Transcutaneous Electrical Nerve Stimulators (TENS), Supplemental Medical Review Contractor (SMRC), Unified Program Integrity Contractor (UPIC), Provider Outreach and Education Advisory Group (POE AG), Healthcare Integrated General Ledger Accounting System (HIGLAS), click here to see all U.S. Government Rights Provisions, American Hospital Association Online Store, HCPCS code is inconsistent with modifier used or a required modifier is missing, Item billed was processed under DMEPOS Competitive Bidding Program and requires an appropriate competitive bid modifier, HCPCS code is inconsistent with modifier used or required modifier is missing, The procedure code/bill type is inconsistent with the place of service, Missing/incomplete/invalid place of service. Claim was submitted to incorrect Jurisdiction, Claim must be submitted to the Jurisdiction listed as the beneficiarys permanent address with the Social Security Administration, Claim was submitted to incorrect contractor. Alternative services were available, and should have been utilized. D20 Claim/Service missing service/product information. No fee schedules, basic unit, relative values or related listings are included in CDT. 139 Contracted funding agreement Subscriber is employed by the provider of services. Item has met maximum limit for this time period. 55 Procedure/treatment is deemed experimental/investigational by the payer. PR B9 Services not covered because the patient is enrolled in a Hospice. D17 Claim/Service has invalid non-covered days. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. 207 National Provider identifier Invalid format. P9 No available or correlating CPT/HCPCS code to describe this service. Your email address will not be published. 62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. PR 140 Patient/Insured health identification number and name do not match.PR 149 Lifetime benefit maximum has been reached for this service/benefit category. Care beyond first 20 visits or 60 days requires authorization. Claims should be filed to the correct payer the beneficiary resides in at the time of claim submission. 53 Services by an immediate relative or a member of the same household are not covered. CO 96- Non-Covered Charges Denial (Not covered under Providers Contract) When the billed Cpt/diagnosis code not listed under the provider's contract then it called Non covered under the provider's plan. 48 This (these) procedure(s) is (are) not covered. This provider was not certified/eligible to be paid for this procedure/service on this date of service. B20 Procedure/service was partially or fully furnished by another provider.

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