This code system https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd defines the following codes:
| Code | Display | Definition |
| A | Covered worker's compensation (Obsolete) | Covered worker's compensation (Obsolete) |
| B | Benefit exhausted | Benefit exhausted |
| C | Custodial care – non-covered care (includes all 'beneficiary at fault' waiver cases) (Obsolete) | Custodial care – non-covered care (includes all 'beneficiary at fault' waiver cases) (Obsolete) |
| E | HMO out-of-plan services not emergency or urgently needed (Obsolete) | HMO out-of-plan services not emergency or urgently needed (Obsolete) |
| E | MSP cost avoided - IRS/SSA/HCFA Data Match (eff. 7/00) | MSP cost avoided - IRS/SSA/HCFA Data Match (eff. 7/00) |
| F | MSP cost avoid HMO Rate Cell (eff. 7/00) | MSP cost avoid HMO Rate Cell (eff. 7/00) |
| G | MSP cost avoided Litigation Settlement (eff. 7/00) | MSP cost avoided Litigation Settlement (eff. 7/00) |
| H | MSP cost avoided Employer Voluntary Reporting (eff. 7/00) | MSP cost avoided Employer Voluntary Reporting (eff. 7/00) |
| J | MSP cost avoid Insurer Voluntary Reporting (eff. 7/00) | MSP cost avoid Insurer Voluntary Reporting (eff. 7/00) |
| K | MSP cost avoid Initial Enrollment Questionnaire (eff. 7/00) | MSP cost avoid Initial Enrollment Questionnaire (eff. 7/00) |
| N | All other reasons for non-payment | All other reasons for non-payment |
| P | Payment requested | Payment requested |
| Q | MSP cost avoided Voluntary Agreement (eff. 7/00) | MSP cost avoided Voluntary Agreement (eff. 7/00) |
| R | Benefits refused, or evidence not submitted | Benefits refused, or evidence not submitted |
| T | MSP cost avoided - IEQ contractor (eff. 9/76) (obsolete 6/30/00) | MSP cost avoided - IEQ contractor (eff. 9/76) (obsolete 6/30/00) |
| U | MSP cost avoided - HMO rate cell adjustment (eff. 9/76) (Obsolete 6/30/00) | MSP cost avoided - HMO rate cell adjustment (eff. 9/76) (Obsolete 6/30/00) |
| V | MSP cost avoided - litigation settlement (eff. 9/76) (Obsolete 6/30/00) | MSP cost avoided - litigation settlement (eff. 9/76) (Obsolete 6/30/00) |
| W | Worker's compensation (Obsolete) | Worker's compensation (Obsolete) |
| X | MSP cost avoided - generic | MSP cost avoided - generic |
| Y | MSP cost avoided - IRS/SSA data match project (obsolete 6/30/00) | MSP cost avoided - IRS/SSA data match project (obsolete 6/30/00) |
| Z | Zero reimbursement RAPs -- zero reimbursement made due to medical review intervention or where provider specific zero payment has been determined. (effective with HHPPS - 10/00) | Zero reimbursement RAPs -- zero reimbursement made due to medical review intervention or where provider specific zero payment has been determined. (effective with HHPPS - 10/00) |
| 00 | MSP cost avoided - COB Contractor | MSP cost avoided - COB Contractor |
| 12 | MSP cost avoided - BCBS Voluntary Agreements | MSP cost avoided - BCBS Voluntary Agreements |
| 13 | MSP cost avoided - Office of Personnel Management | MSP cost avoided - Office of Personnel Management |
| 14 | MSP cost avoided - Workman's Compensation (WC) Datamatch | MSP cost avoided - Workman's Compensation (WC) Datamatch |
| 15 | MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006) | MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006) |
| 16 | MSP cost avoided - Liability Insurer VDSA (eff. 4/2006) | MSP cost avoided - Liability Insurer VDSA (eff. 4/2006) |
| 17 | MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006) | MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006) |
| 18 | MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006) | MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006) |
| 19 | SEE NOTE4: Coordination of Benefits Contractor 11119 (see CMS Change Request 7906 for identification of the contractor.) | SEE NOTE4: Coordination of Benefits Contractor 11119 (see CMS Change Request 7906 for identification of the contractor.) |
| 21 | MSP cost avoided - MIR Group Health Plan (eff. 1/2009) | MSP cost avoided - MIR Group Health Plan (eff. 1/2009) |
| 22 | MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009) | MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009) |
| 25 | MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005) | MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005) |
| 26 | MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005) | MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005) |
| 42 | SEE NOTE4: Coordination of Benefits Contractor 11142 (see CMS Change Request 7906 for identification of the contractor.) | SEE NOTE4: Coordination of Benefits Contractor 11142 (see CMS Change Request 7906 for identification of the contractor.) |
| 43 | SEE NOTE4: Coordination of Benefits Contractor 11143 (see CMS Change Request 7906 for identification of the contractor.) Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code. | SEE NOTE4: Coordination of Benefits Contractor 11143 (see CMS Change Request 7906 for identification of the contractor.) Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code. |
| ! | MSP cost avoided - COB Contractor ('00' 2-byte code) | MSP cost avoided - COB Contractor ('00' 2-byte code) |
| @ | MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code) | MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code) |
| # | MSP cost avoided - Office of Personnel Management ('13' 2-byte code) | MSP cost avoided - Office of Personnel Management ('13' 2-byte code) |
| $ | MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code) | MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code) |
| * | MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006) | MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006) |
| ( | MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006) | MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006) |
| ) | MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006) | MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006) |
| + | MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006) | MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006) |
| < | MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009) | MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009) |
| > | MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009) | MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009) |
| % | MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) (eff. 10/2005) | MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) (eff. 10/2005) |
| & | MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) (eff. 10/2005) | MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) (eff. 10/2005) |
