Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)

by  Jared Staheli
July 6th, 2015

When denying claims for counseling to prevent tobacco use services submitted without diagnosis codes 305.1 or V15.82, contractors shall use the following messages:

MSN 15.4: The information provided does not support the need for this service or item.

MSN Spanish Version: La informaciónproporcionada no confirma la necesidadparaesteservicio o artículo

RARC M64 - Missing/incomplete/invalid other diagnosis

CARC 167 This (these) diagnosis(es) is (are) not covered, missing, or are invalid.

Contractors shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file.

When denying claims for counseling to prevent tobacco use services and smoking and tobacco-use cessation counseling services that exceed a combined total of 8 sessions within a 12-month period (G0436, G0437, 99406, 99407), contractors shall use the following messages:

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

MSN Spanish Version: “Estos servicios no pueden ser pagados porque sus beneficios se han agotado.”

CARC 119: “Benefit maximum for this time period or occurrence has been reached.”

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

Contractors shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file.

Contractors shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file.

References:

Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11). (2015, July 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/medicare-summary-notices-msns-remittance-advice-remark-codes-rarcs-claims-adjustment-reason-codes-carcs-and-group-codes-for-counseling-to-prevent-tobacco-use-rev-2058-01-03-11-27048.html

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