There is a non-payment code present and it is not equal to 'R' or 'Z' and the total covered charges are greater than zero, or there is no non-payment code present. Total covered charges are equal to zero.
Guidelines and Suggestions
Providers should verify if days/units are to be billed as covered or non-covered. If the days/units are non-covered, bill with type of bill (TOB) xx0, condition code 20/21, and the occurrence span codes and corresponding dates for the non-covered days.
Condition code 20 should be billed if the beneficiary has requested that the determination be made by Medicare (i.e., a demand bill) on the coverage of the services. Condition code 21 should be billed if the provider is requesting a denial notice from Medicare for use in billing another payer.
last updated on 07/20/2012