CMS Pub. 100-04, ch. 21, § 40

General Information (GI) messages are used on pages 1 and 2 of the MSN, under the Be

Informed! How to Report Fraud, and Your Messages from Medicare sections. GI

messages are messages that communicate important information about the Medicare

program or that serve as important reminders to beneficiaries. CMS communicates

which messages to use, and when to use them, via Technical Direction Letters (TDLs) or

Change Requests (CRs).

Explanatory and Denial messages appear under the claims section of the MSN. Their

purpose is to concisely communicate essential information to the beneficiary regarding

claim determinations or to serve as an educational tool.

The MSN message file is found at the hyperlink at the bottom of this section. Messages

are grouped in categories for ease of reference only. Unless specific messages are

specified in instructions by CMS, MACs should select and use the most appropriate

message(s) for each situation to explain the action taken on a service, item, or claim.

MACs are instructed to use the most appropriate message for each situation regardless of

message category.

Use multiple messages as appropriate including ones grouped within different categories.

Use the message(s) which best explains the situation(s) in the claim.

All denied or reduced services must have an explanation.

The BBA of 1997 requires the amount of Medicare payment for each service be included

on all Part A Benefit notices, including the MSN and Notice of Utilization (NOU.)

MACs use message 16.53 on all A/B MAC (A) or (HHH) generated notices with

payments.

The MAC may combine “add-on” messages with existing messages to create a single

message within its file.

Each message on the file is tied to an alphabetic code on the MSN. Print no more than

three alphabetic codes per claim level and three alphabetic codes per service line.

Messages containing fill-in blanks may be left as blanks for filling in by the system or

may be entered into the system with blanks pre-filled to create as many specific messages

as there are fill-in situations.

The message numbering in this section does not have to be used in MAC message

generating systems.

Certain messages are mandated. These messages and the situations for which they are

mandated are identified in the MSN message file at the hyperlink at the end of this

section. This does not eliminate the need to use other messages required by instructions

elsewhere in the manual.

Beneficiary liability “Add-on” messages should be printed in addition to denial and

reduction messages for charges which the beneficiary is determined not liable. Liability

“Add-on” messages should print for denials or reductions such as:

• Services that are part of another service or bundled code;

• Services determined not to be medically necessary in situations where the

beneficiary was not notified in writing, prior to receipt of the service, that Medicare may

not make payment;

• Duplicate charges; and

• Denials for utilization reasons.

The complete list of MSN messages is only available electronically. Click on this link to

view them: http://www.cms.gov/Medicare/Medicare-General-

Information/MSN/index.html