Tips to prevent claim adjustment reason code (CARC) PR 96

This denial is received when 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 corrections, 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.

References

• Items & Services Not Covered Under Medicare
• Statutory exclusion from Medicare benefits - §1862(a)