Denial Code Lookup

The amount applied to the patient's deductible. This is a patient responsibility amount, not a denial per se, but frequently confuses providers.

The amount applied as the patient's coinsurance responsibility after the deductible has been met.

The amount collected or to be collected from the patient as a co-payment for the service.

These are non-covered services because this is not deemed a 'medical necessity' by the payer. The payer has determined the service is not medically necessary based on their clinical criteria.

Payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply.

Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.

The authorization number is missing, invalid, or does not apply to the billed services or provider.

Precertification/authorization/notification absent. Required precertification, authorization, or notification was not obtained in a timely manner.

Precertification/notification/authorization number may be required but was not provided or was invalid.

The procedure code is inconsistent with the modifier used, or a required modifier is missing.

Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Could be missing demographics, invalid NPI, or missing modifiers.

Exact duplicate claim/service. The payer has already processed an identical claim with the same information.

The time limit for filing has expired. The claim was not submitted within the payer's required timeframe.

Non-covered charge(s). At least one remark code must be provided to explain the non-covered charges.

The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. This is a bundling denial.

Expenses incurred prior to coverage. The date of service is before the patient's coverage effective date.

Expenses incurred after coverage terminated. The date of service is after the patient's coverage end date.

Claim/service not covered by this payer/contractor. You must send the claim to the correct payer/insurer.

Benefit maximum for this time period or occurrence has been reached. The patient has exhausted their allowed visits or dollar amount for this service category.

This service/equipment/drug is not covered under the patient's current benefit plan.

Services denied at the time of authorization, or at the time the claim was processed, because the service was already provided or paid by another provider.

The rendering provider is not eligible to perform the service billed. This may be due to licensing, credentialing, or network status.

Services not provided by network/primary care provider. The service was rendered by an out-of-network provider.

The procedure code/bill type is inconsistent with the place of service. The billed location does not match where the service should be performed.

The diagnosis is inconsistent with the procedure. The ICD-10 code does not support the CPT/HCPCS code billed.

The diagnosis is inconsistent with the provider type. The diagnosis billed is not within the scope of the billing provider's specialty.

This care may be covered by another payer per coordination of benefits. The payer believes another insurance should be primary.

Patient cannot be identified as our insured. The payer cannot locate the patient in their system with the information provided.

Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. The billed amount is greater than the payer's allowed amount.

This (these) diagnosis(es) is (are) not covered, or are missing or are invalid. The diagnosis code is not payable under the patient's plan.

Payment is denied when performed/billed by this type of provider. The payer does not cover this service when performed by the billing provider's specialty.

Procedure code was invalid on the date of service. The CPT/HCPCS code used has been deleted or was not yet effective.

National Provider Identifier - missing. The required NPI was not included on the claim submission.

National Provider Identifier - Invalid format or not a valid NPI. The NPI number submitted is not in the correct format or does not exist in NPPES.

This procedure is not paid separately. The service is considered part of another procedure and is bundled into that procedure's reimbursement.

This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day.

An attachment/other documentation is required to adjudicate this claim/service. Additional clinical records or documentation must be submitted.

Sequestration - reduction in federal payment. Automatic across-the-board reduction in Medicare payments required by federal law.

Coverage/program guidelines were not met. The payer's specific coverage criteria for this service were not satisfied.