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Patient’s Common Working File (CWF) has not been updated to show Hospice election has been revoked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