CMS Pub. 100-04, ch. 18, § 70.4

Appropriate remittance advice(s) must be used by A/B MACs (A) and (B) when denying payment for glaucoma

screening. The following messages are used where applicable:

• If the services were furnished before January 1, 2002, use existing ASC X12 835 remittance advice claim

adjustment reason code 26 “Expenses incurred prior to coverage” at the line level.

• If the claim for glaucoma screening is being denied because the minimum time period has not elapsed since the

performance of the same Medicare covered procedure, use existing ASC X12 835 claim adjustment reason code

119 “Benefit maximum for this time period has been reached” at the line level.

• If the service is being denied because the individual is not an African-American age 50 or over, use existing

remittance advice claim adjustment reason code 6, “The procedure code is inconsistent with the patient’s age,”

and existing remark codes M83, “Service not covered unless the patient is classified as at high risk,” and M82,

“Service not covered when patient is under age 50.” Report these codes at the line level.

• If the service is being denied because the individual is not a Hispanic-American age 65 or over, use existing

remittance advice claim adjustment reason code 96, “Non-covered charge,” and existing remark codes M83,

“Service not covered unless the patient is classified as at high risk,” and N129, "This amount represents the dollar

amount not eligible due to patient's age."

• If the service is being denied because the patient does not have diabetes mellitus, or there is no family history of

glaucoma, A/B MACs (B) use existing remittance advice claim adjustment reason code B5, “Payment adjusted

because coverage/program guidelines were not met or were exceeded.” The zero payment for the service will

indicate the denial. In addition, report remark code M83, “Service is not covered unless the patient is classified as

at high risk” at the line level.