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Printed Date: 9/22/2015
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.
Medicare Secondary Payer (MSP) claims must contain covered charges and cannot be billed with condition code 20/21. Also, claims reporting condition code 04 or 04/69 should not be billed as non-covered.
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Last Updated: 12/27/2018