US · guidance
CMS Pub. 100-04, ch. 18, § 160.4
Frequency Edits for IBT for CVD Claims
A/B MACs (A) and (B) shall allow claims for G0446 no more than once in a 12-month period.
NOTE: 11 full months must elapse following the month in which the last G0446 IBT for CVD
took place.
MACs shall deny claims IBT for CVD claims that exceed one (1) visit every 12 months.
A/B MACs (A) and (B) shall allow one professional service and one facility fee claim for each
visit.
The following messages shall be used when A/B MACs (A) and (B) deny IBT for CVD claims
that exceed the frequency limit:
CARC 119: “Benefit maximum for this time period or occurrence has been reached.”
RARC N362: “The number of days or units of service exceeds our acceptable maximum.”
MSN 20.5: “These services cannot be paid because your benefits are exhausted at this time.”
Spanish Version: “Estos servicios no pueden ser pagados porque sus beneficios se han agotado.”
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.
History
(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)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9b0fb3dcfec30b2908f67c3f13ae9adbd2956df8b26eaa5a0b3419fc39a60ee0
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