Code | Description |
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01 | Military service related; coordinate with the Department of Veterans Affairs (VA). |
02 | Patient alleges the medical condition or injury causing this episode of care is due to the employment environment or events (e.g., workers' compensation, black lung). |
03 | Patient is covered by an insurance not reflected here. |
04 | Bill is submitted for informational purposes only. |
05 | Lien has been filed. The provider has filed legal claim for recovery of funds potentially due to a patient as a result of legal action initiated by or on behalf of a patient. |
07 | Treatment of a non-terminal condition for a hospice patient. Report this code when the patient has elected hospice care, but the provider is not treating the patient for the terminal condition. |
08 | Beneficiary would not provide information concerning other insurance coverage. The MAC develops to determine proper payment. |
09 | Neither the patient nor the spouse is employed. |
10 | Patient and/or spouse is employed but no Employee Group Health Plan (EGHP) coverage exists. |
11 | Disabled beneficiary but no Large Group Health Plan (LGHP). |
17 | Patient is homeless. |
18 | Maiden name retained. |
19 | Child retains mother's maiden name. |
21 | Billing for denial notice. Provider determined services are at a non-covered level or excluded, but it is requesting a denial notice from Medicare in order to bill Medicaid or other insurers. |
22 | Patient on Multiple Drug Regimen |
23 | Home Care Giver Available |
24 | Home IV Patient Also Receiving HHA Services |
25 | Patient Is a Non-U.S. Resident |
26 | Veteran's Administration (VA) eligible patient chooses to receive services in a Medicare Certified Facility. |
28 | Patient's and/or spouse's EGHP is secondary to Medicare. In response to the Medicare Secondary Payer (MSP) questionnaire, the patient and/or spouse indicated that one or both are employed and that there is group health insurance from an EGHP or other employer-sponsored or provided health insurance that covers the patient but that either: the EGHP is a single employer plan and the employer has fewer than 20 full and part time employees; or the EGHP is a multiple employer plan that elects to pay secondary to Medicare for employees and spouses aged 65 and older for those participating employers who have fewer than 20 employees. |
29 | Disabled beneficiary and/or family member's LGHP is secondary to Medicare. In response to the Medicare Secondary Payer (MSP) questionnaire, the patient and/or family member(s) indicated that one or more are employed and there is group health insurance from an LGHP or other employer-sponsored or provided health insurance that covers the patient but that either: the LGHP is a single employer plan and the employer has fewer than 100 full and part time employees; or the LGHP is a multiple employer plan and that all employers participating in the plan have fewer than 100 full and part-time employees. |
31 | Patient is a student (full time day). |
32 | Patient is a student (cooperative/work study program). |
33 | Patient is a student (full-time night). |
34 | Patient is student (part-time). |
45 | Ambiguous gender category. |
46 | Nonavailability statement on file. |
48 | Identifies claims submitted by a TRICARE-authorized psychiatric RTC for children and
adolescents. This code is not required for Medicare billing. However, it is required for TRICARE billing, when applicable. Medicare will accept this condition code to comply with HIPAA transaction code set requirements. |
52 | Hospice beneficiary moves out of service area, including patients admitted to a hospital that does not have contractual arrangements
with the hospice. |
67 | Beneficiary elects not to use Lifetime Reserve (LTR) days. |
68 | Beneficiary elects to use LTR days. |
77 | Provider accepts or is obligated/required due to contractual arrangement or law to accept payment by a primary payer as payment in full |
78 | Newly covered Medicare service for which an HMO doesn't pay. For outpatient bills, condition code 04 should be omitted. |
H0 | Delayed filing, statement of intent submitted within the qualified period to specifically identify the existence of another third party liability situation. |