Remittance Advice Notices

50.8 - Remittance Advice Notices (Rev. 11021; Issued: 10-01-21; Effective: 10-29-21; Implementation: 10-29-21) If the claim for a screening prostate antigen test or screening digital rectal examination is being denied because the patient is less than 50 years of age, use the ASC X12 835 with • Claim adjustment reason code; 6 “the procedure/revenue code is inconsistent with the patient’s age,” at the line level; and • Remark code M82 “Service not covered when patient is under age 50.” If the claim for a screening prostate specific antigen test or screening digital rectal examination is being denied because the time period between the test/procedure has not passed, A/B MACs (A) and (B) use ASC X12 835 claim adjustment reason code 119, “Benefit maximum for this time period has been reached” at the line level. If the claim for a screening prostate antigen test or screening digital rectal examination is being denied due to the absence of ICD-10-CM diagnosis code Z12.5 on the claim, use the ASC X12 835 claim adjustment reason code 167 – This (these) diagnosis(es) is (are) not covered. RARC N386 – This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.