skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 11/11/2022 Location: FL, PR, USVI Business: Part B

Denial reason code PR 96 FAQ

Q: We received a denial with claim adjustment reason code (CARC) PR 96. What steps can we take to avoid this denial?
PR 96 – Non-covered charge(s).
M16 – Alert: Please see our website, mailings, or bulletins for more details concerning this policy/procedure/decision.
N425 – Statutorily excluded service(s).
A: The denial was received because the service billed is statutorily excluded from coverage under the Medicare program. Payment cannot be made for the service under Part A or Part B.
Review the service billed to ensure the correct code was submitted.
If the claim is being submitted for statutorily excluded services, you can append a GY modifier to the line item. The GY modifier indicates that the item or service is statutorily excluded or does not meet the definition of a Medicare benefit.
If an error was made, make the necessary correction, and resubmit your claim.
If a payable diagnosis is indicated in the patient's medical record, correct the diagnosis, and resubmit the claim.
If a covered service was coded incorrectly, correct the code, and resubmit the claim.
Prevent a duplicate denial: Submit corrected line item(s) only.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.