50 (29) ADJUSTMENT REASON (161.91)

Name	Value
CODE	50
STATUS EFFECTIVE DATE	2003-06-01 00:00:00 STATUS: ACTIVE FEE USE: APPLICABLE
DESCRIPTION EFFECTIVE DATE	DESCRIPTION: These are non-covered services because this is not deemed a `medical necessity' by the payer. DESCRIPTION: These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. DESCRIPTION: These are non-covered services because this is not deemed a 'medical necessity' by the payer. 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	These are non-covered services because this is not deemed a 'medical necessity' by the payer. 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