Medicare denial CO 4, C0 125 , MA 120, CO 16 & MA 83

Denial code CO 4

Denial Message
• The procedure code is inconsistent with the modifier used, or a required modifier is missing (04)

Reason for Denial
• Claim was filed with a procedure code and modifier that did not correspond

How to resolve and avoid future denials

• Verify that the procedure code and modifier descriptions correspond with each other
• File claims with consistent procedure code and modifier descriptions
• Access the Modifier Lookup tool on www.PalmettoGBA.com/bsc

Denial reason code co 125 , MA 120

Denial message
• Payment adjusted due to billing or submission error (125)
• Missing/incomplete/invalid CLIA certification number (120)

Reason for denial
• Claim contains incomplete/or invalid CLIA certification number

How to resolve and avoid future denials

• Resubmit the claim using the appropriate CLIA number in Item 23 of the CMS 1500 claim form or in Loop 2300 or 2400, REF/X4, 02 for electronic claims
• Updates to the waived test under CLIA are published in the Medicare Advisory
• A complete list of tests granted waived status under CLIA is attached to CR 5913 at www.cms.hhs.gov/Transmittals/downloads/ R1477CP.pdf.

Medicare denial code co 16 MA 83

Denial message
•Claim/service lacks information which is needed for adjudication (16)
• Did not indicate whether Medicare is primary or secondary payer (83)

Reason for denial

•The MSP type was not submitted in the 2000B, SBR, 05 (Insurance Type Code) field

How to resolve the denial

• Resubmit the claim with the appropriate MSP type in the Insurance Type Code field
• For a complete list of MSP types
www.PalmettoGBA.com/bsc/resources
o Select Medicare Secondary Payer
o Electronic Claims – Valid MSP Types

Posted in: Denial and action,how to avoid denial