by Jared Staheli
July 5th, 2015
The following MSN messages are used (See Chapter 21 for the Spanish versions of these messages):
A. If a claim for a screening fecal-occult blood test, a screening flexible sigmoidoscopy, or a barium enema is being denied because of the age of the beneficiary, MSN message 18.13 is used.
This service is not covered for patients under 50 years of age.
B. If the claim for a screening fecal-occult blood test, a screening colonoscopy, a screening flexible sigmoidoscopy, or a barium enema is being denied because the time period between the same test or procedure has not passed, MSN message 18.14 is used:
Service is being denied because it has not been (12, 24, 48, 120) months since your last (test/procedure) of this kind.
C. If the claim is being denied for a screening colonoscopy or a barium enema because the beneficiary is not at a high risk, MSN message 18.15is used:
Medicare covers this procedure only for patients considered to be at a high risk for colorectal cancer.
D. If the claim is being denied because payment has already been made for a screening fecal-occult blood test (82270* (G0107*) or G0328), flexible sigmoidoscopy (code G0104), screening colonoscopy (code G0105), or a screening barium enema (codes G0106 or G0120), MSN message 18.16 is used:
This service is denied because payment has already been made for a similar procedure within a set timeframe.
NOTE: MSN message 18-16 should only be used when a certain screening procedure is performed as an alternative to another screening procedure. For example: If the claims history indicates a payment has been made for code G0120 and an incoming claim is submitted for code G0105 within 24 months, the incoming claim should be denied.
E. If the claim is being denied for a noncovered screening procedure code such as G0122, the following MSN message 16.10 is used:
Medicare does not pay for this item or service.
If an invalid procedure code is reported, the contractor will return the claim as unprocessable to the provider under current procedures.
*NOTE: For claims with dates of service prior to January 1, 2007, physicians, suppliers, and providers report HCPCS code G0107. Effective January 1, 2007, code G0107 is discontinued and replaced with CPT code 82270.