Procedure code was invalid on the date of service.
Reason for Non-Coverage
- The procedure code billed is not valid for the date of service or the procedure code is not recognized by Medicare.
Claim Denial vs. Rejection
- CMS IOM Publication 100-4, CH 26. Section 10.1 and 10.4, (Subsection 24D) (PDF, 611 KB)
- CMS IOM Publication 100-4, Ch 23, Sec 30.2.2 (PDF, 1 MB)
Identify the CPT® or HCPCS code that was effective on the date of service billed and that the code is recognized by Medicare. If it is different from the previously billed code, submit a new claim with the correct code. For example, verify the Medicare Physician Fee Schedule Data Base status indicator of the procedure code to ensure that procedure is valid for Medicare purposes.