US · guidance
CMS Pub. 100-04, ch. 17, § 80.1.4
MSN/Claim Adjustment Message Codes for Oral Cancer Drug Denials
If the claim for an oral cancer drug is denied because it was not approved by FDA, is not considered to
be a medically accepted treatment for cancer, or is not the chemical equivalent of a covered injectable
cancer drug (or a covered Prodrug), use the appropriate message on the MSN.
The contractor shall use the following remittance advice messages and associated codes when
rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH
CORE Business Scenario Three.
Group Code: CO
CARC: 114
RARC: N/A
MSN: 6.2, 6.3
History
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2d9e0633c6afa3a4a356c82e3f4e915678c080111ef7bcfa8584d0252d0c347a
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