Reason Code U5200

Description
Centers for Medicare & Medicaid Services (CMS) records indicate that the beneficiary is not entitled to Medicare coverage for this type of services billed on the claim. Therefore, no Medicare payment can be made.

Resolution
The purpose of this edit is to ensure that Medicare pays only for services for which the beneficiary is entitled. The CMS records indicate that beneficiary is not entitled to Medicare coverage for the type of services billed on the claim, therefore; no Medicare payment can be made. Investigate and check the patient’s eligibility. If appropriate, correct and resubmit the claim. Check/Verify Entitlement by calling the Interactive Voice Response (IVR), using the eServices Portal, or via HETS.

Resources
For more information about HETS and how to obtain access to the system, refer to the CMS HETS Help web page on the CMS website.