What will display in the Allowed/Disallowed Flag field 25 of the MAO-004 report when the Allowed/Disallowed Reason Codes field 27 contains value of Q?


Field #25 (Allowed/Disallowed Flag) will be “A” if field #27 (Allowed/Disallowed Reason Codes) is “Q”. ‘Q’= the diagnoses on the current encounter are now allowed due to Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) quarterly update. This value is only applicable to reprocessed outpatient, professional and Durable Medical Equipment (DME) encounters, not to inpatient encounters.  

Source: CMS HPMS Memo with subject “Phase III Version 3 MAO-004 Report Release Date and Announcement Regarding Final Encounter Data Deadlines for Payment Years 2016-17” (December 20, 2017)

Last Updated: 12/20/2017