Medicare Summary Notices (MSNs) and Claim Adjustment Reason Codes (CARCs)

20.3 - Medicare Summary Notices (MSNs) and Claim Adjustment Reason Codes (CARCs) (Rev. 2998, Issued: 07-25-14, Effective: Upon implementation of ICD-10; 01-01-12 - ASC X12, Implementation: 08-25-2014 - ASC X12; Upon Implementation of ICD-10) The following messages are used by Medicare contractors when denying non-covered services associated with KDE services when provided to patients with stage IV CKD: When denying claims for KDE services billed without diagnosis code 585.4 contractors shall use: • MSN 16.10 - Medicare does not pay for this item or service. • CARC 167 - This (these) diagnosis(es) is (are) not covered. NOTE: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. When denying claims for KDE services when submitted for more than 6 sessions contractors shall use: • MSN 15.22 - The information provided does not support the need for this many services or items in this period of time so Medicare will not pay for this item or service. • CARC 119 - Benefit maximum for this time period or occurrence has been reached. When denying claims for KDE services when two claims are billed (professional and institutional) on the same service date, contractors shall use: • MSN 15.5 – The information provided does not support the need for similar services by more than one doctor during the same time period. • CARC 18 – Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO). A/B MACs (A) shall deny KDE services when rendered in an urban area unless: • The provider is a hospital on the section 401 list or • The claim is submitted on TOB 85X. A/B MACs (A) shall deny payment for KDE services when submitted on TOB 72X. Use the following messages: • MSN 21.6 – This item or service is not covered when performed, referred or ordered by this provider. • CARC 170 – Payment is denied when performed/billed by this type of provider in this type of facility. NOTE: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.