55 (32)    ADJUSTMENT REASON (161.91)

Name Value
CODE 55
STATUS EFFECTIVE DATE
  • 2003-06-01 00:00:00
    STATUS:   ACTIVE
    FEE USE:   APPLICABLE
DESCRIPTION EFFECTIVE DATE
  • DESCRIPTION:   
    Claim/service denied because procedure/treatment is deemed 
experimental/investigational by the payer.
  • DESCRIPTION:   
    Procedure/treatment is deemed experimental/investigational by the payer. 
Note: Refer to the 835 Healthcare Policy Identification Segment (loop 
2110 Service Payment Information REF), if present.
  • DESCRIPTION:   
    Procedure/treatment is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
  • DESCRIPTION:   
    Procedure/treatment/drug is deemed experimental/investigational 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 
(loop 2110 Service Payment Information REF), if present.
REMITTANCE REMARK
CORE SCENARIO Billed Service Not Covered
ADJUSTMENT GROUP