BALTIMORE--In a Change Request sent to the DME MACs on Friday, CMS established a number of denial reason codes to be used when processing claims under national competitive bidding.

Among the new denial codes:

--45: "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangment," to be used when the submitted charge on the claim is higher than the allowed charge; and
--96: "Non-covered charge(s)," to be used when denying claims for a beneficiary who resides in a CBA who obtains an item from a non-contract supplier that has not obtained a signed ABN.

The Change Request, No. 6069, noted three new reason codes when denying claims under NCB where a contract suplier submits a claim for oxygen equipment after the payment cap has been reached (maximum of 45 total payments for the beneficiary), or when the payment cap for a capped rental item has been reached (maximum of 25 total payments for the beneficiary):

--B7: "This provider was not certified/eligible to be paid for this procedure/service on this date of service."
--N211: "Alert: You may not appeal this decision."
--N307: "Billing exceeds the rental months covered/approved by the payer."

The new denial codes are effective July 1 with an implementation date of July 7, according to the Change Request.