Reason Code: PR-204

Error Description:

This service/equipment/drug is not covered under the patient's current benefit plan.

Avoiding/Correcting This Error

Medicare Fee-for-Service does not cover the service that has been billed for the condition.

The CPT/HCPCS on the claim is not a covered Medicare service/equipment or drug.

There are multiple reasons for denial which includes the following, but is not limited to:

• Status A Code
• Status R Code
• Status X Code

To avoid future denials please use the following resources, as well as the most current CPT/HCPCS coding books, to verify if the code you want to bill to Medicare is a covered service:

• Medicare Physician Fee Schedule Database (MPFSDB)
• CMS Internet Only Manual (IOM)
• Medicare Coverage Data Base