30940

FISS Narrative
A provider is not permitted to adjust a partially or fully medically denied claim. Reason code 30940 is received when attempting to adjust a claim with a medically denied line. If you are trying to add diagnosis codes, change CPT codes or move denied charges from non-covered to covered, you must submit a redetermination.

Explanation and Suggestion:
There is a medically denied line on the original claim and the provider is attempting to submit an adjustment making changes to a medically denied line or a medically denied line is being removed from the claim.

If claim contains a medically denied line, the only allowed changes are:

  • Change to beneficiaries' Medicare number
  • Removal of charges not previously medically denied
  • Medicare Secondary Payer (MSP) adjustments making Medicare either primary or secondary
  • An increase in charges to a revenue code line that was not denied by Medical Review

If original claim does not include medically denied/reviewed lines, Direct Data Entry (DDE) users may F9 claim to reprocess.

  • "Comments/Remarks" must include changes being made
  • Any other change not listed above must be submitted as an appeal

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

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