Professional Billing Requirements for Screening for Depression in Adults (Rev. 2431, 10-14-11)

by  Jared Staheli
July 7th, 2015

Contractors shall use the following claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), group codes, or Medicare Summary Notice (MSN) messages when denying payment for G0444 when reported more than once in a 12- month period.

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

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

o MSN 20.5 – “These services cannot be paid because your benefits are exhausted as this time.” Spanish Version - “Estos servicios no pueden ser pagados porque sus beneficios se han agotado.”

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.

Contractors shall use the following CARCs, RARCs, group codes, or MSNs messages when denying payment for G0444 and POS codes other than: 11-Office; 22-Outpatient Hospital; 49-Independent Clinic; and 71-State or Local Public Health Center.

o CARC 58 - “Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. 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 MSN 21.25 - “This service was denied because Medicare only covers this service in certain settings.”

Spanish Version - “El servicio fue denegado porque Medicare solamente lo cubre en ciertas situaciones."

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:

Professional Billing Requirements 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/professional-billing-requirements-for-screening-for-depression-in-adults-rev-2431-10-14-11-27071.html

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