"EDIT","LO_VERSION","HI_VERSION","DISPOSITION_ID","BUFFER","NAME","DESCRIPTION"
"1","60","87","3","Diagnosis","Invalid diagnosis code","The principal diagnosis field is blank, there are no diagnoses entered on the claim, or the entered diagnosis code is not valid."
"2","60","87","3","Diagnosis","Diagnosis and age conflict","The diagnosis code includes an age range, and the age reported is outside that range."
"3","60","87","3","Diagnosis","Diagnosis and sex conflict","The diagnosis code includes sex designation, and the sex does not match. This edit is bypassed if condition code 45 is present on the claim."
"4","60","87","4","Procedure","Medicare secondary payer alert","The procedure code has a MSP alert warning indicator. This edit applies to v1.0 and v1.1 only, and is not applicable for reason for visit diagnosis."
"5","60","87","3","Diagnosis","External cause of morbidity code cannot be used as principal diagnosis","The diagnoses reported is a morbidity code and cannot be used as the principal diagnosis."
"6","60","87","3","Procedure","Invalid procedure code","HCPCS code is not valid for the selected version of the program."
"7","60","87","3","Procedure","Procedure and age conflict (inactive)","N/A."
"8","60","87","3","Procedure","Procedure and sex conflict","The sex of the patient does not match the sex designated for the procedure code reported. This edit is bypassed if condition code 45 is present on the claim."
"9","60","87","6","Revenue Center","Non-covered under any Medicare outpatient benefit for reasons other than statutory exclusion","The procedure code is flagged as non-covered for reasons other than statute exclusion or revenue code is 099x with status indicator ""E1"" and is submitted without a HCPCS code. This edit is bypassed when code G0428 is present with status indicator ""E""."
"10","60","87","2","Procedure","Service submitted for denial","The claim has condition code 21 present."
"11","60","87","4","Procedure","Service submitted for MAC review","The claim has condition code 20 present."
"12","60","87","4","Procedure","Questionable covered service","The procedure reported is flagged as a questionably covered service."
"13","60","87","5","Procedure","Separate payment for services is not provided by Medicare","The claim is OPPS and the bill type is 12/14x without condition code 41 or the bill type is 13x, and the HCPCS code is on the ""Separate payment for service not provided by Medicare"" list (SI=E2) or the claim is non-OPPS and the bill type is any other than those defined for OPPS claims (above), the HCPCS code is on the ""Separate payment for service not provided by Medicare"" list and the status indicator is not B."
"14","60","87","3","Procedure","Code indicates a site of service not included in OPPS","This procedure code has a Not included in OPPS indicator. This edit applies to v1.0-v6.3 only."
"15","60","87","3","Procedure","Service unit out of range for procedure (inactive)","The maximum units allowed is greater than zero and the sum of the service units for all line items with the same procedure code on the same day exceeds the maximum allowed for this procedure and Modifier 91 is not present but the HCPCS code is not on the list of laboratory/pathology codes which are exempt from this edit."
"16","60","87","3","Procedure","Multiple bilateral procedures without modifier 50","The same bilateral procedure code occurs two or more times on the same service date. This edit is applied to all relevant procedure lines for dates of service prior to 10/01/05 only."
"17","60","87","3","Procedure","Inappropriate specification of bilateral procedure","The same inherent bilateral procedure code occurs two or more times on the same service date. This edit is applied to all relevant bilateral procedure lines, except when modifier 76 or 77 is submitted on the second or subsequent line or units of an inherently bilateral code. Note: For codes with an SI of V that are also on the Inherent Bilateral list, condition code G0 will take precedence over the bilateral edit; these claims will not receive edit 17. This edit is also bypassed if the bill type is 85x."
"18","60","87","6","Procedure","Inpatient procedure","A line has a C status indicator and is not on the ""separate procedure"" list or A line has a C status indicator and is on the ""separate procedure"" list, but there are no type T lines on the same day. All other line items on the same day as the line with a C status indicator are denied (line item denial/rejection flag = 1, APC return buffer) and edit 49 is assigned on all line items. *This is the only edit that can cause one or more days of a multiple-day claim to be denied, or single day claim with all lines denied. No other edits are performed on any lines with edits 18 or 49."
"19","60","87","5","Procedure","Mutually exclusive procedure that is not allowed by NCCI even if appropriate modifier is present","A pair of procedures reported on a claim in which one of the procedures is identified by NCCI to be mutually exclusive and cannot be reported together on the same day. The second procedure within the NCCI pair will obtain edit 19."
"20","60","87","5","Procedure","Code2 of a code pair that is not allowed by NCCI even if appropriate modifier is present","The second procedure reported is part of an NCCI pair, which will cause the generation of edit 20 to LIR even in the presence of a modifier."
"21","60","87","3","Procedure","Medical visit on the same day as a type T or S procedure without modifier 25","One or more type T or S procedures occur on the same day as a line item containing an E & M code, without modifier 25. See Medical Visit Processing logic for more information."
"22","60","87","3","Modifier","Invalid modifier","The modifier is not in the list of valid modifier entries and the revenue code is not 540."
"23","60","87","3","Date","Invalid date","A From, Through, or Service date is invalid or a service date falls outside of the From/Through date range. This edit terminates processing for the claim."
"24","60","87","4","Claim","Date out of OCE range","The From or Through date falls outside the range of any version of the program. This edit terminates processing for the claim."
"25","60","87","3","Procedure","Invalid age","The age is non-numeric or outside the range of 0-124 years."
"26","60","87","3","Procedure","Invalid sex","The sex is non-numeric or outside the range of 0-2."
"27","60","87","1","Procedure","Only incidental services reported","All line items are incidental (status indicator N). If edit 27 is present no other edits are performed."
"28","60","87","5","Procedure","Code not recognized by Medicare for outpatient claims; alternate code for same service may be available","The procedure code has a ""Not recognized by Medicare"" indicator."
"29","60","87","3","Procedure","Partial hospitalization service for non-mental health diagnosis","The principal diagnosis is not related to mental health."
"30","60","87","6","Procedure","Insufficient services on day of partial hospitalization","If less than 3 PHP services are reported for any one day, the day is denied and the lines return edit 30. See Partial Hospitalization Processing logic for more information."
"31","60","87","4","Procedure","Partial hospitalization on same day as ECT or type T procedure","Electroconvulsive therapy or a significant procedure (SI=T) occurs on the same day as partial hospitalization, and APC 33 partial hospitalization) is assigned to a mental health service on the same day."
"32","60","87","4","Procedure","Partial hospitalization claim spans 3 or less days with insufficient services on at least one of the days","A claim 4ed for medical review (edit 30) does not span more than three days."
"33","60","87","4","Procedure","Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services","A claim 4ed for medical review (edit 30) spans more than three days. However, partial hospitalization services were not provided on at least 57% 4/7) of the days."
"34","60","87","4","Procedure","Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria","A claim 4ed for medical review (edit 30) spans more than three days and partial hospitalization services were provided on at least 57% 4/7) of the days. However, on the days when partial hospitalization services were provided, less than 75% of the days met the partial hospitalization day of service criteria i.e., edit 30 occurred on the line item)."
"35","60","87","3","Procedure","Only Mental Health education and training services provided","Only education and training services are present without other mental health service; the claim fails mental health status."
"36","60","87","4","Procedure","Extensive mental health services provided on day of type T procedure","Electroconvulsive therapy or a non-mental health type T procedure APC is present on the same day as extensive mental health service."
"37","60","87","3","Procedure","Terminated bilateral procedure or terminated procedure with units greater than one","A modifier 52 or 73 is present, as well as: an independent or conditional bilateral procedure with modifier 50 or a procedure with units greater than 1."
"38","60","87","3","Procedure","Inconsistency between implanted device or administered substance and implantation or associated procedure","The status indicator is H, U, or APC 987-997 (Implant) is present, but no type S, T, or non-implant type X procedures are present on the claim (v1.0-15.3 only). There is a code with status indicator H or U present, but no type S, T, or J1 procedures are present on the same claim. See Device-Dependent Procedure Editing and Processing for more information."
"39","60","87","5","Procedure","Mutually exclusive procedure that would be allowed by NCCI if appropriate modifier were present (combined with edit 40 retroactive to earliest included version)","The procedure is one of a pair of mutually exclusive procedures in the NCCI table coded on the same day, where the modifier was either not coded or is not an NCCI modifier. Only the code in column 2 of a mutually exclusive pair is rejected; the column 1 code of the pair is not marked as an edit."
"40","60","87","5","Procedure","Code2 of a code pair that would be allowed by NCCI if appropriate modifier were present","The procedure is identified as part of another procedure on the claim coded on the same day, where the modifier was either not coded or is not an NCCI modifier. Only the code in column 2 of a code pair is rejected; the column 1 code of the pair is not marked as an edit."
"41","60","87","3","Revenue Center","Invalid revenue code","The revenue code is not in the list of valid revenue codes or the revenue code is reported prior to/exceeding its NUBC effective date."
"42","60","87","3","Procedure","Multiple medical visits on same day with same revenue code without condition code G0","Multiple medical visits (based on units and/or lines) are present on the same day with the same revenue code, without condition code G0 to indicate that the visits were distinct and independent of each other. See Medical Visit Processing for more information."
"43","60","87","3","Procedure","Transfusion or blood product exchange without specification of blood product","A blood transfusion or exchange is coded but no blood product is reported."
"44","60","87","3","Procedure","Observation revenue code on line item with non-observation HCPCS code","A 762 (observation) revenue code is used with a HCPCS other than observation 99217-99220, 99234-99236, G0378, reported."
"45","60","87","5","Procedure","Inpatient separate procedures not paid","On the same day, all lines with status indicator C are on the ""separate procedure"" list, and there is at least one type T or J1 line. (Note: Lines with SI=C if reported on a claim with a C-APC procedure SI=J1, the lines with the inpatient-separate procedure return edit 45.)."
"46","60","87","3","Procedure","Partial hospitalization condition code 41 not approved for type of bill","Bill type 12x or 14x is present with condition code 41. Edit 46 terminates processing only for those bill types where no other edits are applied."
"47","60","87","5","Procedure","Service is not separately payable","The claim consists entirely of a combination of lines that: are denied or rejected or have a status indicator N Edit 47 is assigned to all lines with status indicator N, or that change from Q to N, that are not already denied or rejected and have no other service on the claim."
"48","60","87","3","Revenue Center","Revenue center requires HCPCS","The bill type is 13x, 74x, 75x, 76x, or 12x/14x without condition code 41, HCPCS is blank, and the revenue center status indicator is not N or F. This edit is bypassed when the revenue code is 100x, 210x, 310x, 099x, 0905-0907, 0500, 0509, 0583, 0660-0663, 0669, 0931, 0932, 0521, 0522, 0524, 0525, 0527, 0528, 0637, or 0948; see also edit 65."
"49","60","87","6","Procedure","Service on same day as inpatient procedure","A service is reported on the same day as a C status indicator."
"50","60","87","3","Revenue Center","Non-covered under any Medicare outpatient benefit","based on statutory exclusion, The Code reported is on ""statutory exclusion"" list or the Revenue code is 0637 with SI of E when submitted without a HCPCS code."
"51","60","87","3","Procedure","Observation code G0378 not allowed to be reported more than once per claim","HCPCS code G0378 is reported more than once on a 13x or 85x claim/bill type. The edit is applicable to the subsequent lines of G0378 only. Edit 51 is bypassed if the subsequent G0378 line(s) has a line item action flag of 2, 3,  or 4 present."
"52","60","87","3","Procedure","Observation does not meet minimum hours, qualifying diagnoses, and/or ""T"" procedure conditions","The observation period is less than 8 hours or there is no diagnosis of CHF, chest pain or asthma or there is a T procedure (except 90780) on the same or previous day."
"53","60","87","5","Procedure","Codes G0378 and G0379 only allowed with bill type 13x or 85x","Codes G0378 and/or G0379 appear on the claim and the bill type is not 13x or 85x."
"54","60","87","3","Procedure","Multiple codes for the same service","Any of the following three pairs of codes appear on the same claim; C1012 and P9033, C1013 and P9031, or C1014 and P9035."
"55","60","87","3","Procedure","Non-reportable for site of service","The procedures reported are non-reportable for the site of service indicated."
"56","60","87","3","Procedure","E/M condition not met and line item date for obs code G0378 is not 12/31/ or 1/1","There is no specified E/M code the day of or the day preceding the observation and the date of observation is not 12/31/yyyy or 1/1/yyyy."
"57","60","87","4","Procedure","E/M condition not met for observation and line item date for code G0378 is 1/1","There is no specified E/M or critical care visit the day of or the day preceding the observation and the date of observation is 01/01/yyyy."
"58","60","87","3","Procedure","Direct admittance G0379 only allowed with obervation G0378","Code G0379 is present without code G0378 for the same line item date."
"59","60","87","3","Procedure","Clinical trial requires diagnosis code V707 as other than primary diagnosis (deleted retroactive to the earliest included version)","Code G0292, G0293 or G0294 is present and diagnosis code V70.7 is not present as admit or secondary diagnosis."
"60","60","87","3","Procedure","Use of modifier CA with more than one procedure not allowed","Modifier CA is present on more than one line or Modifier CA is submitted on a line with multiple units. (see Inpatient Procedure Processing)."
"61","60","87","3","Procedure","Service can only be billed to the DMERC","The procedure code has a ""DME-only"" indicator."
"62","60","87","3","Procedure","Code not recognized by OPPS; alternate code for same service may be available","The procedure code has a ""Not recognized by Medicare for OPPS"" indicator. Services with a status indicator of B always return edit 62."
"63","60","87","3","Procedure","Occupational therapy service only billable on partial hospitalization claims","Occupational therapy services are present and the bill type is 12x or 13x without condition code 41."
"64","60","87","5","Procedure","Activity therapy service not payable outside the partial hospitalization program","Activity therapy services are present and the bill type is 12x or 13x without condition code 41."
"65","60","87","5","Revenue Center","Revenue code not recognized by Medicare","The revenue code is 100x, 210x, 310x, 0500, 0509, 0583, 0660-0663, 0669, 0905-0907, 0931, or 0932; see also edit 48."
"66","60","87","4","Procedure","Code requires manual pricing","The HCPCS code is an unclassified drug code."
"67","60","87","6","Procedure","Service provided prior to FDA approval","The line item date of service of a code is prior to the date of FDA approval."
"68","60","87","6","Procedure","Service provided prior to date of National Coverage Determination (NCD) approval","The line item date of service of a code is prior to the code activation date."
"69","60","87","6","Procedure","Service provided outside approval period","The service was provided outside the period approved by CMS."
"70","60","87","3","Procedure","CA modifier requires patient discharge status indicating expired or transferred","CA modifier requires patient discharge status indicating expired or transferred. (See Inpatient Procedure Processing)."
"71","60","87","3","Procedure","Claim lacks required device code","A specified procedure is submitted on a claim without the code (s) for the required devices). This edit is bypassed if the procedure is terminated - modifier 52, 73, or 74.)."
"72","60","87","3","Procedure","Service not billable to the Medicare Administrative Contractor","A code has a status indicator M. This edit is bypassed when the bill type is 85x and revenue code is 096x, 097x, or 098x. This edit is also bypassed when the bill type is 81x or 82x and the revenue code is 657."
"73","60","87","3","Procedure","Incorrect billing of blood and blood products","Blood product claims lack two identical lines (of HCPCS code, units, and modifier BL), one line with revenue code 38x and the other line with revenue code 39x. See Blood and Blood Storage Processing for more information."
"74","60","87","3","Procedure","Units greater than one for bilateral procedure billed with modifier 50","Any code on the Conditional or Independent bilateral list is submitted with modifier 50 and units of service are greater than one on the same line."
"75","60","87","3","Modifier","Incorrect billing of modifier FB or FC","Modifier FB or FC is present and SI is not S, T, V or X."
"76","60","87","5","Procedure","Trauma response critical care code without revenue code 068x and CPT 99291","Trauma response critical care code is present without revenue code 068x and CPT code 99291 on the same date of service."
"77","60","87","3","Procedure","Claim lacks allowed procedure code","A specified device is submitted on a claim without a code for an allowed procedure, and the bill type is not 12x."
"78","60","87","3","Procedure","Claim lacks required radiolabeled product","A specified nuclear medicine procedure is submitted on a claim without the code for a required radiopharmaceutical."
"79","60","87","3","Procedure","Incorrect billing of revenue code with HCPCS code","The revenue code is 381 with a HCPCS code other than packed red cells (P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9057, P9058) or The revenue code is 382 with a HCPCS code other than whole blood P9010, P9051, P9054, and P9056). See Blood and Blood Storage Processing for more information."
"80","60","87","3","Procedure","Mental health code not approved for partial hospitalization","Mental health HCPCS codes that are not approved for partial hospitalization program submitted on bill type 13x with condition code 41, or bill type 76x."
"81","60","87","3","Procedure","Mental health service not payable outside the partial hospitalization program","Mental health HCPCS codes that are not payable outside the partial hospital program submitted on bill type 12x or 13x without condition code 41."
"82","60","87","3","Procedure","Charge exceeds token charge ($1.01)","Code C9898 is billed with charges greater than $1.01."
"83","60","87","6","Procedure","Service provided on or after effective date of NCD","The line item date of service of a code is on or after the date of non-coverage determination."
"84","60","87","3","Procedure","Claim lacks required primary code","Certain claims are returned to the provider if a specified add-on code is submitted without a code for a required primary procedure on the same date of service (edit 84). Add-on codes 33225, 90785, 90833, 90836 or 90838 are submitted without one of the required primary codes on the same day. (Note: Psychiatric add-on codes are edited only on PHP claims)."
"85","60","87","3","Procedure","Claim lacks required device code or required procedure code","Code C9732 and C1840 not submitted together on the same day. (Code for insertion of ocular telescopic lens submitted without the code for the intraocular lens, or vice versa). Discontinued insertion procedures (indicated by the presence of modifier 52, 73 or 74 on the line) are not returned for a missing telescopic lens code."
"86","60","87","3","Diagnosis","Manifestation code not allowed as principal diagnosis","A diagnosis code considered to be a manifestation code from the Medicare Code Editor (MCE) manifestation diagnosis list is reported as the principal diagnosis code on a hospice bill type claim 81X, 82X)."
"87","60","87","3","Procedure","Skin substitute application procedure without appropriate skin substitute product code","A List A skin substitute application procedure is submitted without a list A skin substitute product; or a list B skin substitute application procedure is submitted without a list B skin substitute product on the same date of service. See Skin Substitute Editing and Processing logic for more information."
"88","60","87","3","Procedure","FQHC payment code not reported for FQHC claim","FQHC payment code not reported for a claim with bill type 77x and without Condition Code 65. Note: If the bill type is 770 (No payment claim), edit 88 is not applicable. Note: Edit 88 is bypassed for FQHC PPS claims when Telehealth originating site services HCPCS code Q3014 or Chronic Care Management HCPCS 99490 is reported and there is no FQHC payment code; also edit 88 is bypassed for FQHC when only FQHC non-covered services are present with edit 91. See FQHC Processing for more information."
"89","60","87","3","Procedure","FQHC claim lacks required qualifying visit code","FQHC payment code reported for FQHC claim (bill type is 77x without Condition Code 65) without a qualifying visit HCPCS. Note: Edit 89 is bypassed for FQHC PPS claims when Telehealth originating site services HCPCS code Q3014 or Chronic Care Management HCPCS 99490 is reported and there is no FQHC payment code or qualifying visit code present; also edit 89 is bypassed for FQHC when only FQHC non-covered services are present with edit 91. See FQHC Processing for more information."
"90","60","87","3","Revenue Center","Incorrect revenue code reported for FQHC payment code","FQHC payment code not reported with revenue code 519, 52X or 900. See FQHC Processing for more information."
"91","60","87","5","Procedure","Item or service not covered under FQHC PPS or for RHC","A service considered to be non-covered under FQHC PPS or for RHC is reported. See FQHC Processing for more information."
"92","60","82","3","Procedure","Device-dependent procedure reported without device code","A device-dependent procedure is reported without a device code. See Device-Dependent Procedure Editing and Processing for more information."
"92","83","87","3","Procedure","Device-intensive procedure reported without device code","A device-intensive procedure is reported without a device code."
"93","60","87","5","Procedure","Corneal tissue processing reported without cornea transplant procedure","Corneal tissue processing HCPCS (V2785) is reported and there is no corneal transplant procedure present for the same service date."
"94","60","87","3","Procedure","Biosimilar HCPCS reported without biosimilar modifier","A biosimilar HCPCS code is reported on the claim without its corresponding biosimilar manufacturing modifier which re presents the biosimilar manufacturer. See Biosimilar HCPCS processing for more information."
"95","60","87","5","Procedure","Weekly partial hospitalization services require a minimum of 20 hours of service as evidenced in PHP plan of care","A PHP claim contains weekly PH services that total less than 20 hours per 7-day span. This edit applies to v17.2 with a disposition of RTP, and effective v18.3-Present, with a disposition of LIR. See Partial Hospitalization Processing logic for more information."
"96","60","87","3","Procedure","Partial hospitalization interim claim from and through dates must span more than 4 days","An interim PHP claim (bill type 763 or 133 with condition code 41) From and Through date spans less than 5 days. See Partial Hospitalization Processing logic for more information. 17.2 only."
"97","60","87","3","Procedure","Partial hospitalization services are required to be billed weekly","A PHP claim From and Through date spans more than 7 days. See Partial Hospitalization Processing logic for more information. 17.2 only."
"98","60","87","3","Procedure","Claim with pass through device lacks required procedure","A pass-through device is present without an associated, required procedure. See Pass-Through Device Processing for more information."
"99","60","87","3","Procedure","Claim with pass-through or non-pass-through drug or biological lacks OPPS payable procedure","There is a pass-through drug or biological HCPCS code present on a claim without an associated OPPS procedure with SI = J1, J2, P, Q1, Q2, Q3, R, S, T, U, V. See Special Processing for Drugs and Biologicals for more information."
"100","60","87","3","Procedure","Claim for HSCT allogeneic transplantation lacks required revenue code line for donor acquisition services","A claim reporting HSCT allogeneic transplantation (procedure code 38240) is reported and there is no additional line on the claim reporting revenue code 815 for donor acquisition service. See HSCT and Donor acquisition services processing."
"101","60","87","3","Procedure","Item or service with modifier PN not allowed under PFS","Modifier PN is reported for an item or service that is considered to be non-excepted for an off-campus provider-based hospital outpatient department under Section 603. See Section 603 Logic for more information."
"102","60","87","3","Procedure","Modifier pairing not allowed on the same line","A line item is reported with a pair of modifiers that have conflicting meaning and should not be reported together. Please reference the data files for a report named Modifier Pairs, which contains an up to date list of modifiers not allowed to be reported on the same line. Note: Edit 102 is updated in v20.0 retroactively to inception (1/1/17) , to not allow any conflicting modifiers to be reported on the same hcpcs line."
"103","60","87","6","Modifier","Modifier reported prior to FDA approval date","A modifier is reported before its activation date for reporting. See biosimilar HCPCS processing. 19.0 only."
"104","60","87","5","Procedure","Service not eligible for all-inclusive rate","An RHC claim (71x) is reported with a line containing the CG modifier."
"105","60","87","6","Procedure","Claim reported with pass-through device prior to FDA approval for the procedure","A procedure is reported with a device before the FDA approval date. The edit is returned on the line containing the device. See Device Pass-Through processing."
"106","60","87","6","Procedure","Add-on code reported without required primary procedure code","A claim is submitted with a Type I add-on code(s) without the applicable defined primary procedure(s). The edit is returned on the add-on code line(s) when conditions of the edit are not met. See Add-on Code Edit Processing for more information."
"107","60","87","6","Procedure","Add-on code reported without required contractor-defined primary procedure code","A claim with bill type 85x (CAH) is submitted with a Type II add-on code(s) reported with a professional services revenue code (96x, 97x or 98x), to allow for contractors to review and define the primary procedure on the claim. See Add-on Code Edit Processing for more information."
"108","60","87","6","Procedure","Add-on code reported without required primary procedure or required contractor-defined primary procedure code","A claim is submitted with a Type III add-on code(s) without a defined primary(s) or contractor defined primary(s) on the same day. This edit is returned on the add-on code line(s) when conditions are not met. See Add-on Code Edit Processing for more information."
"109","60","87","3","Procedure","Code first diagnosis present without mental health diagnosis as the first secondary diagnosis","A PHP claim is submitted with a Code First Diagnosis without a mental health diagnosis in the first secondary diagnosis position. If the first secondary diagnosis position is blank edit 109 is still returned. Note: Edit 29 is suppressed from being returned if a code first diagnosis is present in the pdx position. See PHP processing section for more information."
"110","60","87","5","Procedure","Service provided prior to initial marketing date","The reported line item date of service of a code is prior to the initial marketing date, for which it can be reported."
"111","60","87","5","Procedure","Service cost is duplicative; included in cost of associated biological","The reported line item is considered duplicative as the routine costs of all steps in creating a biological are bundled into the covered benefit, the biological."
"112","60","87","5","Procedure","Information-Only Service","The reported line item is a non-covered service as it is for informational reporting purposes only. Any HCPCS identified as being an information only service is assigned a non-covered status indicator and is line item rejected with no impact on payment."
"113","77","87","3","Diagnosis","Supplementary or additional code not allowed as principal diagnosis","The principal diagnoses code reported is considered supplementary or an additional code and cannot be used as the principal diagnoses (Unacceptable Principal Diagnosis)."
"114","78","87","3","Procedure","Item or service not allowed with modifier CS","Modifier CS is reported on an item or service that is not on the coinsurance waiver eligible list. Modifier CS should only be reported on items that are identified by CMS as being eligible for a coinsurance waiver"
"115","82","87","6","Procedure","COVID-19 lab add-on code reported without required primary procedure","HCPCS U0005 is reported on a claim without one of its primary procedures U0003 or U0004 on the same date of service."
"116","78","87","3","Procedure","Opioid treatment program service not payable outside the opioid treatment program","Opioid Treatment Program HCPCS codes are reported on a bill type that is not approved for an Opioid Treatment Program provider."
"117","84","87","5","Procedure","Token charge less than $1.01 billed by provider","A drug HCPCS with final SI= K or G is reported with charges that are less than $1.01 and at least $0.01. The edit is not applied if a line item action flag or 2, 3, or 4 is present on the drug line(s)."
"118","60","87","3","Claim","Invalid bill type","A claim is submitted with a bill type that is not programmed to process in the IOCE"
"119","60","87","3","Claim","Invalid claims processing receipt date","The Claims processing receipt date is invalid (malformed) or the date falls outside the date range of any version of the IOCE program."
"120","60","87","3","Procedure","Incorrect reporting of modifier PT","A claim is submitted with only one procedure from the surgical ranges (10000-69999 or 0000T-9999T) with modifier PT. This is edit is returned at the line level."
"121","62","87","6","Procedure","Non-covered service reported with inpatient only procedure where the patient expired or transferred","Non-covered services, identified with status indicators B, E1, E2, C or M, should not be paid separately when reported on a claim with an inpatient-only procedure and modifier CA."
"122","87","87","5","Procedure","340B-acquired drug modifier(s) reported inappropriately","Modifier used to report 340B-acquired drugs reported inappropriately. This is an information only edit that sets the Line Item Denial Rejection flag = 3."
