TRICARE Overseas Program Provider Manual

TRICARE overseas Program
Provider Manual
Appendix
ToP: Explanation of Benefits Denial Codes and Remarks
Code Description Additional Information
003
See Item Five on Reverse. If you are not satisfied with our determination, you have
the right to request a review within 90 days of the date of this notice.
SECTIoN 8 / APPENDIX
Acronyms
004 Non-prescription drug – see Item Four on Reverse.
008 Routine X-ray not covered – see Item Four on Reverse.
009 Non-covered routine eye examination – see Item Four on Reverse.
010 Routine lab not covered – see Item Four on Reverse.
013 Eyeglasses/lenses not covered – see Item Four on Reverse.
014 Routine foot care not covered – see Item Four on Reverse.
018 Provider not TRICARE-authorized for this service.
019 Personal comfort item not covered – see Item Four on Reverse.
020 This charge included in a paid service.
This is used when the Provider is
billing for a procedure that is
already accounted for in another
procedure. For example, removal
of cerumen (ear wax) is included in
the office visit charge.
027 Authorized service limits exceeded – see Item Four on Reverse.
028 Requested Information Not Received.
030 Service Filed After Time Limit.
032 Non-covered Services.
033 Duplicate of Services Previously Claimed (Manual).
Services billed are not a covered
service according to TRICARE
Policy.
Upon manual review, it was
determined this charge is a
duplicate and has been paid
previously on another line/claim.
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