US · guidance
CMS Pub. 100-04, ch. 1, § 180.2
Denial Code
Prior to the publication of the new CARC #213, there was no specific code to describe claims
that are denied based on a violation of the physician self-referral statute at Section 1877 of the
Act. A specific code is appropriate so both the providers of DHS and the industry know that
claims are being denied based on the non compliance with the physician self-referral
prohibitions. This code should be used any time a claim is denied because the physician (or an
immediate family member of the physician) has a financial interest in a DHS provider and fails
to meet one of the exceptions available in 42 C.F.R. §§411.355-411.357.
History
(Rev. 1578, Issued: 08-15-08, Effective: 01-01-09, Implementation: 01-05-09)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
f983763ad12ba5830e7f35b66ece14c73d573bc5e8883fe56f59e234f94fcea1
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