Medicare denial A0 - A8 , B1 ,B8, B9 - B23

 PR-B8 Alternative services were available, and should have been utilized.

 Common Reasons for Message

    Medical documentation is lacking medical necessity

Next Step

    Verify medical documentation for the following:
        Service is appropriate to bill
        Date of Service
        Contains Signature
        Include vital signs
        Reason for ambulance transport (explain medical necessity)
    Verify if a modifier is required
    Submit an Appeal request - Items or services with this message have appeal rights

        Submit documentation with Redetermination request.


B9 Patient Enrolled in Hospice

Common Reasons for Message

    Patient is enrolled in Hospice on date of service

        Medicare Part B only pays for physician services notrelated to Hospice condition and not paid under arrangement with Hospice entity

    Patient's Common Working File (CWF) has not been updated to show Hospice election has been revoked

Next Step

    Append Hospice modifier if appropriate

        Modifier GV - Attending physician is not employed or paid under agreement by patient's Hospice provider

        Modifier GW - Condition not related to patient's terminal condition

    Submit Appeal request - Items or services with this message have appeal rights


A0    Patient refund amount.
A1    Claim denied charges.
A2    Contractual adjustment.
A3    Medicare Secondary Payer patient liability met.
A4    Medicare Claim PPS Capital Day Outlier Amount.
A5    Medicare Claim PPS Capital Cost Outlier Amount.
A6    Prior Hospitalization or 30-day transfer requirement not met.
A7    Presumptive Payment Adjustment.
A8    Claim denied; ungroupable DRG
B1    Non covered visits.
B2    *Covered visits.
B3    *Covered charges.
B4    Late filing penalty.
B5    Claim/service denied/reduced because coverage guidelines were not met or were exceeded.
B6    This service/procedure is denied/reduced when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty.
B7    This provider was not certified for this procedure/service on this date of service.
B8    Claim/service not covered/reduced because alternative services were available, and should have beenutilized.
B9    Services not covered because the patient is enrolled in a Hospice.
B10    Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
B11    The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.
B12    Services not documented in patients' medical records.
B13    Previously Paid. Payment for this claim/service may have been provided in a previous payment.
B14    Claim/service denied because only one visit or consultation per physician per day is covered.
B15    Claim/service denied/reduced because this procedure/service is not paid separately.
B16    Claim/service denied/reduced because "New Patient" qualifications were not met.
B17    Claim/service denied because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current.
B18    Claim/service denied because this procedure code/modifier was invalid on the date of service or claim submission.
B19    Claim/service denied/reduced because of the finding of a Review Organization.
B20    Charges denied/reduced because procedure/service was partially or fully furnished by another provider.
B21    *The charges were reduced because the service/care was partially furnished by an other physician.
B22    This claim/service is denied/reduced based on the diagnosis.
B23    Claim/service denied because this provider has failed an aspect of a proficiency testing program.

Medicare denial reason code -1
Medicare denial reason code - 2
Medicare denial reason code - 3
Denial EOB
Medicare EOB
Denial claim example
Denial claim
Medicare denial codes
For full list

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