CMS Pub. 100-04, ch. 18, § 190.7

A/B MACs (A) and (B) shall use the appropriate CARC, RARC, group codes, or MSN messages

when denying payment for annual depression screening in adults:

• For RHCs and FQHCs when screening for depression, HCPCS code G0444, with another

encounter/visit with the same line-item date of service, use group code CO and :

o CARC 97 - “The benefit for this service is included in the payment/allowance for

another service/procedure that has already been adjudicated. Note: Refer to the 835

Healthcare Policy Identification Segment (loop 2110 Service Payment Information

REF) if present.”

• Denying claims containing HCPCS code G0444, submitted on a TOB other than 13X,

71X, 77X, and 85X:

o MSN 21.25 - “This service was denied because Medicare only covers this service in

certain settings.”

o CARC 170 - “Payment is denied when performed/billed by this type of provider.

Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service

Payment Information REF), if present.”

o RARC N428 - “Not covered when performed in this place of service.”

o 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.

o 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.

• Denying claims containing HCPCS code G0444, depression screening in adults, more

than once in a 12-month period:

o MSN 20.5 - “These services cannot be paid because your benefits are exhausted at this

time.”

o CARC 119 - “Benefit maximum for this period or occurrence has been reached.”

o RARC N362 - “The number of days or units of service exceeds our acceptable

maximum.”

o 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.

o 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.