CARCs, RARCs, Group Codes, and MSN Messages for Screening for Depression in Adults (Rev. 2431, 10-14-11)

by  Jared Staheli
July 7th, 2015

Contractors shall use the appropriate CARC, RARC, group codes, or MSN messages when denying payment for annual depression screening in adults:

• For RHCs and FQHCs when screening for depression, HCPCS code G0444, with another encounter/visit with the same line-item date of service, use group code CO and :

o CARC 97 – “The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) if present.”

• Denying claims containing HCPCS code G0444, submitted on a TOB other than 13X, 71X, 77X, and 85X:

o MSN 21.25 – “This service was denied because Medicare only covers this service in certain settings.”

o CARC 170 - “Payment is denied when performed/billed by this type of provider. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.”

o RARC N428 – “Not covered when performed in this place of service.”

o Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.

o Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.

• Denying claims containing HCPCS code G0444, depression screening in adults, more than once in a 12-month period:

o MSN 20.5 – “These services cannot be paid because your benefits are exhausted at this time.”

o CARC 119 – “Benefit maximum for this period or occurrence has been reached.”

o RARC N362 – “The number of days or units of service exceeds our acceptable maximum.”

o Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.

o Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.

References:

CARCs, RARCs, Group Codes, and MSN Messages for Screening for Depression in Adults (Rev. 2431, 10-14-11). (2015, July 7). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/carcs-rarcs-group-codes-and-msn-messages-for-screening-for-depression-in-adults-rev-2431-10-14-11-27074.html

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