167 (174) ADJUSTMENT REASON (161.91)

Name	Value
CODE	167
STATUS EFFECTIVE DATE	2005-06-30 00:00:00 STATUS: ACTIVE FEE USE: APPLICABLE
DESCRIPTION EFFECTIVE DATE	DESCRIPTION: This (these) diagnosis(es) is (are) not covered. DESCRIPTION: This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. DESCRIPTION: This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
ASSOCIATED SUSPEND CODE	File: 161.27, IEN: 4
SUSPENSION DESCRIPTION	This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
REMITTANCE REMARK
CORE SCENARIO	Billed Service Not Covered
ADJUSTMENT GROUP