Claim Medicare Non-Payment Reason Code Table

A = Covered worker's compensation (Obsolete)
B = Benefit exhausted
C = 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)
E = MSP cost avoided — IRS/SSA/HCFA Data Match (eff. 7/2000)
F = MSP cost avoids HMO Rate Cell (eff. 7/2000)
G = MSP cost avoided Litigation Settlement (eff. 7/2000)
H = MSP cost avoided EmployerVoluntary Reporting (eff. 7/2000)
J = MSP cost avoids Insurer Voluntary Reporting (eff. 7/2000)
K = MSP cost avoids Initial Enrollment Questionnaire (eff. 7/2000)
N = All other reasons for non-payment
P = Payment requested
Q = MSP cost avoided Voluntary Agreement (eff. 7/2000)
R = Benefits refused, or evidence not submitted
T = MSP cost avoided — IEQ contractor (eff. 9/1976) (obsolete 6/30/2000)
U = MSP cost avoided — HMO rate cell adjustment (eff. 9/1976) (Obsolete 6/30/2000)
V = MSP cost avoided — litigation settlement (eff. 9/1976) (Obsolete 6/30/2000)
W = Worker's compensation (Obsolete)
X = MSP cost avoided — generic
Y = MSP cost avoided — IRS/SSA data match project (obsolete 6/30/2000)
Z = Zero reimbursement RAPs — zero reimbursement made due to medical review intervention or where provider specific zero payment has been determined. (eff. with HHPPS — 10/2000)
00 = MSP cost avoided — COB Contractor
12 = MSP cost avoided — BCBS Voluntary Agreements
13 = MSP cost avoided — Office of Personnel Management
14 = 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)
16 = MSP cost avoided — Liability Insurer VDSA (eff. 4/2006)
17 = MSP cost avoided — No-Fault Insurer VDSA (eff. 4/2006)
18 = MSP cost avoided — Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006)
19 = REFERENCE NOTE4: Coordination of Benefits Contractor 11119 (reference CMS Change Request 7906 for identification of the contractor.)
21 = MSP cost avoided — MIR Group Health Plan (eff. 1/2009)
22 = MSP cost avoided — MIR non-Group Health Plan (eff. 1/2009)
25 = MSP cost avoided — Recovery Audit Contractor — California (eff. 10/2005)
26 = MSP cost avoided — Recovery Audit Contractor — Florida (eff. 10/2005)
42 = REFERENCE NOTE4: Coordination of Benefits Contractor 11142 (reference CMS Change Request 7906 for identification of the contractor.)
43 = REFERENCE NOTE4: Coordination of Benefits Contractor 11143 (reference CMS Change Request 7906 for identification of the contractor.)

Effective 4/1/2002, 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 and 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 — BC/BS Voluntary Agreements ('12' 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 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 — 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 — 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 — 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)