CMS Pub. 100-04, ch. 18, § 160.2.1

Professional Claims

(Rev. 2432, Issued: 03-23-12, Effective: 11-08-11, Implementation: 12-27-11 non-shared system edits, 04-02-12 shared system edits, 07-02-12 CWF/HICR/MCS MCDST)

A/B MACs (B) shall pay for IBT CVD, G0446 only when services are provided at the following

POS:

11- Physician’s Office

22-Outpatient Hospital

49- Independent Clinic

72-Rural Health Clinic

Claims not submitted with one of the POS codes above will be denied.

The following messages shall be used when A/B MACs (B) deny professional claims for

incorrect POS:

Claim Adjustment Reason Code (CARC) 58: “Treatment was deemed by the payer to have been

rendered in an inappropriate or invalid place of service.” NOTE: Refer to the 835 Healthcare

Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

Remittance Advice Remark Code (RARC) N428: “Not covered when performed in this place of

service.”

Medicare Summary Notice (MSN) 21.25: “This service was denied because Medicare only

covers this service in certain settings.”

Spanish Version: El servicio fue denegado porque Medicare solamente lo cubre en ciertas

situaciones."

Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim

is received with a GA modifier indicating a signed ABN is on file.

Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is

received with a GZ modifier indicating no signed ABN is on file.