31947

FISS Narrative:
An outpatient claim has a line item with provider submitted non-covered (NC) charges equal to the total charges.

Explanation and Suggestion:
Condition code (CC) 20, 21 or occurrence code (OC) 32 is not present on the claim to indicate the NC reason.

  • OC 32 = Advance Beneficiary Notice (ABN) given; report with appropriate liability-related modifier & covered charges
  • CC 20 = Demand bill will be reviewed
  • CC 21 = No-payment, automatically process

You may refer to the CMS Internet-Only Manual (IOM) 100-4, Chapter 1, Section 60 – Provider Billing of Non-covered Charges on Institutional Claims.

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