US · guidance
CMS Pub. 100-04, ch. 32, § 140.4.2.5
Edits for PR Services Exceeding 72 Sessions
Effective for claims with dates of service on and after January 1, 2010, through December 31, 2021, CWF shall
reject PR claims that exceed 72 sessions. Medicare contractors shall deny PR claims that exceed 72 sessions
regardless of whether the -KX modifier is submitted on the claim line.
The following messages shall be used when Medicare contractors deny PR claims that exceed 72 sessions:
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.”
Contractors shall use Group Code PR assigning financial liability to the beneficiary, if a claim is received with a
GA modifier indicating a signed ABN is on file.
Contractors shall use Group Code CO assigning financial liability to the provider, if a claim is received with a
GZ modifier indicating no signed ABN is on file.
Effective for claims with dates of service on and after January 1, 2022, Medicare Contractors shall deny PR
claims that exceed 72 sessions only when the -KX modifier is not submitted on the claim line.
History
(Rev. 12497; Issued: 02-08-24; Effective: 01-01-24; Implementation: 03-12-24)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3543648e0e648a0f35e78419d8d7a5d61db9aedbfb391a81e3201f3c34fd7dfe
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