- Outpatient Services for Registered Inpatients
- Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Annual Wellness Visits ‑ Billing Tips for Physicians
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Billing Medicare Part A When VA-Eligible Medicare Beneficiaries Receive Services in Non VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Electronically Submitted Claims that Exceed $99,999.99
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
- Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims
Billing Medicare for a Denial - Condition Code 21
Medicare will not pay for services excluded by statute. For claims submitted to Medicare, these excluded services that are not a Medicare benefit may be:
- Not submitted to Medicare at all
- Submitted as a noncovered line item, or
- Submitted on an entirely noncovered claim
To submit statutory exclusions as noncovered line items on claims with other covered services, modifier GY- can be appended on the noncovered line items. To submit statutory exclusions on entirely noncovered claims, use the condition code 21, a claim-level code, signifying that all charges that are submitted on the claim are noncovered charges.
Condition code 21 can also be used to indicate a no payment claim is being submitted at a beneficiary’s request, or other insurer’s request, to obtain a denial from Medicare in order to receive payment from another insurer. These no-payment claims are referred to as “billing for denial” when they are submitted with the condition code 21 (billing for denial notice).
Submit the condition code 21 claim as follows:
- All charges must be submitted as noncovered
- No modifiers that signify beneficiary/provider liability are necessary
- The 3rd position of the type of bill must be zero
- Total charges must be noncovered
- All basic required claim elements must be completed
Nocovered charges on these claims will be denied. The Medicare beneficiary will be liable for these claims.
Note that the no-payment bill that is submitted using the condition code 21 is only used for services that are not in dispute, as opposed to noncovered charges that are submitted on a demand bill (condition code 20).
Providers may reference the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 60.1.3 for more information.