Reason code number | Description |
101 | More details of service required to assess benefit. |
102 | No amount charged is shown on voucher (bulk bill). No amount charged is shown on account/receipt (patient claims). |
103 | Letter of explanation is being sent separately. |
104 | Balance of benefit due to claimant. |
105 | Benefit paid to provider as requested. |
106 | Servicing provider unable to be identified. |
107 | Benefit paid on item number other than that claimed. |
108 | Benefit is not payable for the service claimed. |
110** | Benefit paid - details verified with provider/claimant (internal message only). |
111 | No benefit payable - claim(s) over 2 years old. |
113 | Total charge shown on account apportioned over all items. |
115 | Benefit recommended for this item. |
117 | Benefit not recommended for this item. |
120 | Age restriction applies to this Item. |
122 | Associated referral/request line not required. |
123 | Benefit paid on radiology item other than service claimed. |
124 | Item is restricted to persons of opposite sex to patient. |
125 | Not payable without associated operation/anaesthetic item. |
126 | Service is not payable without radiology service. |
127 | Maximum number of additional fields already paid. |
128 | Benefit paid on associated fracture/amputation item. |
129 | Service is not payable without the base item(s). |
130 | Referred to National Office for decision. |
131 | Date of service not supplied/invalid. |
134 | Single course of treatment paid as subsequent attendance. |
135 | Provider not a consultant physician - specialist rate paid. |
136 | Referral details not supplied- paid at general practitioner (GP) rate. |
137 | Details of requesting provider not shown on account/receipt. |
138 | Benefit only payable when self-determined/deemed necessary. |
139 | Approved pathologist should not use this item number. |
140 | Non-specialist provider. |
141 | No benefit payable for service performed by this provider. |
142 | Documents forwarded to Tier 2 Assessing and benefits. |
144 | Claim benefit not paid - further assessment required. |
150 | Member has not supplied details to permit claim payment. |
151 | Associated service already paid-adjustment being processed. |
154 | Diagnostic Imaging Multiple Service Rule applied to service. |
155 | Overseas service - refer to MPS Assessing. |
157 | Service possibly aftercare - refer to provider. |
158 | Benefit paid on associated abandoned surgery/anae item. |
159 | Item associated with other service on which benefit payable. |
160 | Maximum number of services for this item already paid. |
161 | Adjustment to benefit previously paid. |
162 | Benefit has been previously paid for this service. |
163 | Surgical/anaesthetic item(s) already paid for this date. |
164 | Assistant surgeon benefit not payable. |
166 | Claim over 2 years old - pended to Tier 2 Assessing and benefits. |
168 | Not payable without associated operation/anaesthetic item. |
169 | Operation/anaesthetic item not claimed. |
170 | Assistant anaesthetic benefit not payable. |
171 | Benefit not payable - provider may only act in one capacity. |
173 | Patient episode coning - maximum number of services paid. |
174 | Patient episode coning adjustment. |
175 | Benefit paid on associated foetal intervention item. |
176 | Pay each foetal intervention item as a separate item. |
177 | Foetal intervention item paid using derived fee item. |
179 | Benefit not payable - associated service already paid. |
184 | Benefit paid for additional time item using a derived fee. |
190** | Short term pend - to look at another screen (Internal message only). |
194 | Provider under investigation - refer to supervisor. |
195 | Patient under investigation - refer to supervisor. |
205** | Re-issue of previously cancelled cheque (Internal message only). |
206 | Item number does not attract a benefit at date of service. |
208 | Card number used has expired. |
209 | Claimant’s name stated is different to that on card number. |
211 | Patient not covered by this card number at date of service. |
212 | Date of service used is in the future. |
214 | Claim form not complete. |
215 | Service claimed before 1 February 1984. |
217 | Patient cannot be identified from details supplied. |
222 | Benefit paid on associated anaesthetic item. |
223 | Service not payable - specified item not claimed/present. |
225 | Patient contribution substantiated-additional benefit paid. |
226 | Date of service is before patient’s date of birth. |
227 | Date of service before date eligible for Medicare benefit. |
228 | Date of service after benefit period for overseas visitor. |
229 | Benefit paid at 100% of schedule fee. |
230 | Combination of 85% and 100% of schedule fee paid. |
232 | Service claimed not covered by Medicare. |
233 | Provider not entitled to Medicare benefit at date of service. |
234 | Service for diplomat - benefit not payable. |
236 | Health screening services. |
237 | Health screening - insufficient details. |
238 | Not paid because all associated services rejected. |
240 | Gap adjustment to benefit previously paid. |
241 | Total charge and benefit for multiple procedure. |
242 | Service is part of a multiple procedure. |
243 | Apportioned charge and total benefit for multiple procedure. |
244 | Benefit not paid - service line in error. |
245 | Benefit paid on service other than that claimed. |
246 | Patient cannot be identified from details supplied. |
250 | Explanation/voucher will be forwarded separately. |
251 | Details of requesting provider not supplied. |
252 | Service possibly aftercare. |
253 | Radiotherapy assessed with other item number on statement. |
254 | Assessment incomplete - further advice will follow. |
255 | Benefit assigned has been increased. |
256 | Benefit not payable on this service for a hospital patient. |
260 | Benefit assessed with associated item on statement. |
261 | Associated surgical items/anaesthetic time not supplied. |
262 | Insufficient prolonged anaesthetic time - service not paid. |
264 | Benefit not payable - compensation/damages service. |
265 | Service not covered by reciprocal health care agreement. |
267 | Service not payable - associated service not present. |
271 | Not payable without associated ophthalmological item. |
272 | Benefit paid on associated ophthalmological item. |
274 | Provisional payment. |
280 | Cannot identify service. Resubmit with correct Medicare Benefits Schedule (MBS) item. |
282 | Date of Service outside of referral/request period. |
306 | Card# not valid at date of service-future claims may reject. |
307 | Claim not paid - card number not valid for date of service. |
308 | In vitro fertilisation (IVF) service - conditions not met - no benefit payable. |
316 | Benefit not payable - item cannot be self-determined. |
317 | Benefit not payable - additional item to those requested. |
320 | Quoted Medicare card number is incorrect. |
322 | Provider not approved for this Medicare pathology benefit. |
325 | Laboratory not accredited for benefits for this service. |
326 | Laboratory not accredited for benefits at date of service. |
328 | Benefit paid on associated tomography item. |
329 | Not payable without associated tomography item. |
331 | Benefit not payable - Health Insurance Act 1973 section 20A (1). |
332 | Category 5 lab - benefit not payable for requested service. |
333 | Provider must claim time-based items. |
334 | All associated pathology/Patient Episode Initiation (PEI) items must be either inpatient or outpatient services. |
335 | Service is not payable without nuclear medicine service. |
336 | Benefit paid on nuclear medicine item other than one claimed. |
337 | Provider must claim content-based items. |
338 | Provider not registered to claim benefits at date of service. |
339 | Benefit paid at the concession rate. |
340 | Refund of co-payment amount. |
341 | No referral details - details required for future claims. |
342 | Referral expired - paid at un-referred (GP) rate. |
343 | Card number quoted on claim form has been cancelled. |
344 | Concession number invalid - benefit paid at general rate. |
345 | No safety net entitlement - benefit paid at general rate. |
346 | Co-payment not made - $2.50 credited to threshold. |
347 | Safety net threshold reached - benefit increased. |
348 | Overpayment of claim - invalid concession number. |
349 | Replacement for requested electronic funds transfer (EFT) payment rejected by bank. |
350 | Hospital referral - paid at specialist/consultant rate. |
351 | Benefit not payable - LCC number incorrect or not supplied. |
352 | Service date outside LCC registration dates. |
353 | Pathology items not present. No benefit payable. |
356 | Documentation required to process service. |
358 | Documentation not received - unable to process claim. |
359 | Documentation not received - unable to process claim. |
360 | No benefit payable when requested by this provider. |
361 | Diagnostic Imaging (DI) exemption - items not approved. |
363** | PEI paid in association with R3EX pathology services. |
364 | Items claimed must be as a combination item. |
365** | Benefit paid for S4B3 item. |
366** | Benefit paid for Rule 3 Exemption item. |
367 | Service associated with Medicare Benefits Advisory Committee (MBAC) item in a multiple procedure. |
370 | Benefit paid on item number other than that claimed. |
371 | Future claims quoting old style card no. will be rejected. |
372 | Old style card number quoted - benefit not payable. |
373 | Expired card - benefit not payable. |
374 | Old card issue used - benefit not payable - also refer @. |
375 | Service being processed manually. |
377 | Number of patients seen not indicated. |
378 | Provider cannot refer/request service at date of request. |
380** | Pend - referred to Assessing section (Internal message only). |
385** | Pend - Telephone claim (Internal message only). |
388** | Pend - referred to Partial Payments Control Section (Internal message only). |
390 | Documentation not received. |
391 | Service provider on db1 differs from transmitted data. |
392 | Benefit amount changed. |
393 | No benefit payable - baby not an admitted inpatient. |
395 | Transport Accident Commission (TAC) medical excess. |
397 | Service not related to current compensation case (Internal message only). |
400 | Equipment number missing or invalid. |
401 | Benefit not payable - charge amount missing or invalid. |
402 | Benefit not payable- number of patients attended required. |
403 | Subsequent consultation - referral details required. |
404 | Benefit not payable - referral/request details required. |
405 | Equipment number invalid for servicing provider. |
406 | Supporting text required to assess the claim. |
407 | Benefit not payable - overseas student. |
408 | Date of service before 29 May 1995. |
409 | Card number for this enrolment needs to be verified. |
410 | Age restriction applies for this item - verify details. |
411 | MBAC determination/precedent number not supplied or invalid. |
412 | Benefit not payable - provider unable to claim this service. |
413 | Benefit not payable - date of service before date of request. |
414 | Provider practice location is closed at date of service. |
415 | Referral details same as rendering provider - self-deemed? |
416 | Services form a composite item - composite item required. |
417 | Referral needed - if no referral, NR item to be transmitted. |
418 | Item cannot be claimed more than once in one attendance. |
419 | Benefit already paid on item - verify if multiple pregnancy. |
420 | Operation(s) schedule fee does not meet item description. |
421 | Wrong assistant item used for the operation(s) performed. |
422 | Benefit paid has been reduced (benefit = charge). |
423 | Optical condition not specified - No benefit payable. |
424 | More details required - which eye was treated. |
425 | Benefit not payable - individual charges required. |
426 | Indicate whether new treatment or continuing management. |
427 | Compensation related services - please forward documents. |
428 | Date of service over 2 years - late lodgement form required. |
429 | Patient cannot be identified from the details supplied. |
430 | Conflicting referral details - please clarify. |
431 | Initial consultation previously paid - query subsequent con. |
432 | Not Multi-op - more details required to pay benefit. |
433 | Associated referral/request line not required. |
434 | Expired or invalid card. Benefit not payable. |
435 | Service for nursing home care recipient/benefit not paid. |
436 | Cannot claim out of hospital service through Simplified bill. |
437 | Card details invalid. A new Medicare number has been issued. |
438 | Consultation and DI item(s) not payable on same day. |
439 | Referring/requesting provider not in eligible area. |
440 | Multiple echocardiogram services rule applied. |
441 | Multiple echocardiogram and DI services rule applied. |
442 | Patient not MyMedicare registered with provider practice. |
443 | MyMedicare patient or provider not at or linked to practice |
444 | Required eligible base item not present in the same claim. |
445 | Benefit paid on associated base item. |
446 | Total benefit for plastic & reconstructive procedure paid. |
447 | Evidence is required. Resubmit with account/voucher |
449 | HELD EFT payment reprocessed - incorrect claimant selected. |
450 | EFT details invalid - cheque issued for benefit. |
451 | Service provided in an ineligible location. |
452 | Resubmit claim for this service - image not claim related. |
453 | Resubmit claim for service - claim details do not match image. |
454 | Resubmit claim for service - some details not shown on image. |
455 | Resubmit claim for this service - include account and receipt. |
457 | No action required - line adjusted to process claim. |
458 | No action required - benefit paid on adjusted claim. |
460** | Evidence supplied – benefit paid. (Internal message only). |
461 | Adjustment to benefit previously paid. |
475 | Patient/service details invalid or missing. |
500 | Rejected in association with another item in this claim. |
501 | Group attendance or item format invalid (Bulk Bill). |
502 | Patient is not eligible to claim benefit for this item. |
503 | Referral date format is invalid. |
504 | Charge amount missing /invalid - no benefit payable. |
505 | More details required - evidence of condition. |
506 | Consultation not payable on same day as surgical procedure. |
507 | Site not accredited for this service. |
509 | Service paid as item 2712/2719. |
510 | Service paid as item 52-96/or similar item. |
511 | Extended Medicare Safety Net (EMSN) threshold reached - cap applied to benefit. |
512 | Multiple Musculoskeletal magnetic resonance imaging (MRI) Service Rule applied. |
513 | Multiple Musculoskeletal MRI and DI Services Rules applied. |
514 | Required Equipment Type Code not on Location Specific Practice Number (LSPN) Register. |
515 | Equipment is older than allowable age for this item. |
516 | Ben paid for base and derived radiotherapy items claimed. |
517 | EMSN threshold reached - 80% out of pocket paid. |
518 | Benefit paid at 100% schedule fee + EMSN. |
519 | EMSN threshold reached - partial 80% out of pocket paid. |
520 | Benefit paid at 100% schedule fee + part 80% out of pocket. |
521 | Part 80% out of pocket + between 85% and 100% increase. |
522 | Benefit paid - EMSN + between 85% and 100% schedule fee. |
523** | Charge entered is greater than 350% of the schedule fee. |
524 | Safety net benefit adjusted. |
525 | Only attracts benefit when claimed via Medicare bulk billing. |
528 | Provider not in eligible area (incorrect Rural, Remote and Metropolitan Areas (RRMA), SSD or state). |
529 | Bulk bill additional item claimed incorrectly. |
530 | Patient not on concession/under 16 years at Date of Service. |
535 | Missing data. |
536 | Location Specific Practice Number not supplied. |
537 | Location Specific Practice Number invalid. |
538 | Location Specific Practice Number not recognised. |
539 | Location Specific Practice Number not valid at date of service. |
540 | Enhanced Primary Care Plan not previously claimed. |
549 | Bulk bill incentive item already paid - adjustment required. |
550 | Associated service not claimed - no benefit payable. |
551 | Specimen Collection Point is incorrect or not supplied. |
552 | Specimen Collection Point not valid at date of service. |
553 | Approved Collection Centre number not supplied. |
554 | Total benefit for Anaesthetic service. |
555 | Benefit paid on Main Relative Value Guide (RVG) Anaesthetic item. |
556 | RVG time item not claimed. |
557 | Associated RVG anaesthetic service not claimed. |
558 | RVG anaesthetic item not claimed. |
559 | Patient outside age range - please verify age. |
560 | RVG item restriction. |
561 | Benefit paid on RVG item claimed. |
562 | Benefit paid on associated RVG anaesthetic item. |
563 | Associated RVG service already paid. |
564 | Multiple Vascular Ultrasound services site rule applied. |
565 | Multiple DI and Vascular Ultrasound service rules applied. |
566 | Total benefit for Diagnostic Imaging Service. |
567 | Benefit paid on main Diagnostic Imaging Item. |
568 | Item cannot be substituted. |
569 | Provider unable to substitute. |
600 | Requesting/referring provider unable to be identified. |
601 | In hospital services cannot be claimed as out of hospital. |
602 | Out of hospital service cannot be claimed as in hospital. |
603 | Newborn not yet enrolled with Medicare - no benefit payable. |
604 | Service over 2 years old - late lodgement form required. |
605 | Referral expired - no benefit payable. |
606 | Referring provider number not open at date of referral. |
607 | Referral date has been omitted. |
608 | Referring and servicing provider same - no benefit payable. |
609 | Service/Claim cancelled at provider's request. |
610 | Provider specialty not consistent with item claimed. |
611 | Referral/request details not supplied - no benefit payable. |
612 | Date of referral after date of service - no benefit payable. |
613 | Card number cannot be identified from details supplied. |
614 | No benefit payable - please note time of each visit. |
615 | Multiple procedures - note times and area of treatment. |
616 | Item cannot be claimed as an in hospital service. |
617 | Item cannot be claimed as an out of hospital service. |
618 | No benefit if requested by this provider at date of request. |
619 | Servicing provider number not open at date of service. |
620 | Duplicate transmission - no further payment made. |
621 | Item not claimable electronically (internal message only) This reason code is used to reject services that are not permitted to be claimed via any electronic claiming method such as Bulk Bill EDI, HIC Online, Pharmacy Connectivity Incentive (PCI), PCS or DBS, Eclipse or Simplified Billing EDI. |
622 | Positron Emission Tomography (PET) dropdown menu not claimable via EDI. |
623 | PET items only claimable via direct bill. |
624 | PET items - payee provider required. |
625 | Payee provider not eligible to claim PET items. |
627 | PDT statement NOT provided by the Service Officer. |
629 | Initial PDT therapy item NOT present on patient history. |
633 | Refer back to the specialist referring provider closed. |
634 | Refer back to the specialist - servicing provider is closed. |
635 | Late Lodgement not approved - Letter being sent separately. |
636 | Benefit reduced - dental cap broken. |
637 | No benefit payable - dental cap reached. |
638 | Derived fee and other item cannot be claimed in-hospital. |
639 | Provider not in an eligible area to claim this item. |
640 | More than one base and derived item claimed. |
641 | More than one base item claimed. |
642 | Benefit paid for derived and other item claimed. |
643 | Derived item assessed with other item on statement. |
700 | Benefit cannot be determined for this service. |
701 | Benefit cannot be determined due to complex assessing rules. |
702 | Item restrictive with another item. |
703 | Duplicate of item already quoted. |
704 | Provider not permitted to claim this item. |
705 | No associated pathology service. |
706 | Provider not associated with a pathology laboratory. |
707 | Pathology laboratory not registered at date of service. |
708 | Item cannot be claimed from this pathology laboratory. |
709 | Another assistant item should be claimed. |
710 | Associated surgical items not present. |
711 | Unable to determine associated surgery. |
712 | Base item not present or in incorrect order. |
713 | Radiotherapy fields greater than maximum allowable. |
714 | Benefit not determined - number of time units not present. |
715 | Number of time units exceeded maximum allowable. |
716 | Service forms a composite item - composite item required. |
717 | Benefit not payable on this service for a hospital patient. |
718 | Provider location closed at date of service. |
719 | Benefit cannot be calculated for Hyperbaric Oxygen Therapy. |
720 | Eligibility cannot be determined for this item. |
732 | Referral period not valid for referring provider. |
812 | Details of transferred Medicare assessment - underpayment. |
814** | Details of transferred Medicare assessment - overpayment (internal message only). |
815** | Overpayment of transferred benefit recorded. |
816 | Details of revised Medicare assessment - underpayments involved. |
818 | Details of revised Medicare assessment - overpayments involved. |
819** | Partial overpayment of benefit recorded. |
821 | No Change to original benefit - recorded for history purposes. |
831** | Underpayment of less than $2.00 - no adjustment cheque issued. |
841** | No change to Original Benefit - Record transferred for history purposes. |
851** | Underpayment of less than $2.00 - Transferred - no cheque issued. |
861** | Adjustment to Medicare benefit previously paid. |
881** | Adjustment to transferred Medicare benefit previously paid. |
888 | Details of previous Medicare assessment. |
889** | Details of previous Medicare assessment (transferred). |
890 | Details of suppressed unrelated service - HIC. |
891 | Details of suppressed unrelated service - MOL. |
892 | Details of suppressed unrelated service - Compliance. |
898 | Details of previous Medicare assessment - Suppressed. |
980 | Item line adjusted by system - patient contribution. |
999 | Line has been reversed. |
LCR** | Repay cancelled service. |
LOC** | Service cancelled. |
LSC** | Stale cheque written back. |
LSE | Left eye treated. |
RSE | Right eye treated. |
SRG | Pay benefit to surgeon for service of assistant. |
SUB** | New referral period generated from subsequent con item. |
UCS** | Unclaimed cheque cancelled - returned address indicator set. |
WOD** | Overpayment written off - no recovery attempted. |
| @ | New card issued - quote this number on future claims. |
| # | Card used at time of service not old issue. |
| % | Card expired - future claims may be rejected. |
+ | New card number used - claimant no longer on card used. |
Expand all
MCC137 Online history and assessment indicator changes 29 Oct 2002