Appendix B Explanation of Benefits: Error List

---

The following table lists the error messages that can be reported on the Explanation of Benefits report that detail why a claim item is denied by the system. Review the error messages and take appropriate corrective actions and then resubmit the claim for payment.

Error ID	Error Message	Description
100	DENIED: BCCP identifiation number is missing in record.
101	DENIED: BCCP identification number submitted is not valid.
102	DENIED: BCCP identification number not enrolled for date of service.
200	DENIED: BCCP agency number missing in record.
201	DENIED: BCCP agency number submitted not valid
202	DENIED: BCCP site missing in record
203	DENIED: BCCP site number submitted not valid
204	DENIED: BCCP site number designated as inactive
205	DENIED: NPI number missing in record
206	DENIED: NPI number in record doesn't match provider file
300	DENIED: The client's last name is missing in record
301	DENIED: The client's first name is missing in record
400	DENIED: Date of service missing in record
401	DENIED: Date of service is an invalid date
402	DENIED: Date of service is a future date
403	DENIED: Date of service is more than year old from date of submission
500	DENIED: Date of birth missing in record
501	DENIED: Date of birth represents an invalid date
502	DENIED: Date of birth represents a future date
503	DENIED: The date of service is before the date of birth
600	DENIED: Client sex not indicated
601	DENIED: Client sex not a valid answer
700	DENIED: Diagnosis code 1 missing
701	DENIED: Diagnosis code 1 invalid (includes not covered)
800	DENIED: CPT code missing or invalid
801	DENIED: CPT code not covered or CPT/modifier combo not covered
802	DENIED: Place of service missing or not covered
803	DENIED: Modifier invalid
805	DENIED: Combination of facility status and location of service invalid
851	WARNING: Charged amount exceeds maximum billed at maximum
852	WARNING: Multiple units not covered; only first unit paid
900	DENIED: Insufficient data
901	DENIED: No cycle open for date of service
902	DENIED: Cycle of correct type not open on date of service
903	DENIED: Not payable. Breast and cervical cycles incomplete
904	DENIED: CPT 99080 payable only once per enrollment1
9001	DENIED: Payable only when primary diagnosis code is breast related
9002	DENIED: Payable only when primary diagnosis code is cervical related
9003	DENIED: 19102 or 19103 required on same date of service2
9004	DENIED: 57454, 57455, or 57456 not billable on same date of service3
9005	DENIED: 10022, 19000, 19102, 19103, 19290, or 19291 also required4
9006	DENIED: Not payable on same date of service as 881645
9007	DENIED: Not payable on same date of service as 881426
9008	DENIED: Must be used in conjunction with 88142 or 881647
9009	DENIED: 19291 must be used in conjunction with 192908
9010	DENIED: 19001 must be used in conjunction with 190009
9011	DENIED: 19000, 19001, 19102, 19103, 19290 or 19291 also required10
9012	DENIED: Cervical CPT code submitted with breast related diagnosis code
9051	WARNING: Second and subsequent units paid at reduced rates
9052	WARNING: Max charge for anesthesia exceeded. Set to max.
9959	State exception claim	Indicates that the State has overriden the programmed business rules for this item.
9999	DENIED: Duplicate claim - billing agency has already paid for services

1 99080: Data collection fee: payable when all required client data has been entered into BCCP Web Data System. 2 19102: Biopsy with imaging guidance; percutaneous, needle core, using imaging guidance. 19103: Biopsy with imaging guidance; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance. 3 57454: Colposcopy with biopsy of the cervix and/or endocervical curettage; surgical procedure only. 57455: Colposcopy with biopsy of the cervix. 57456: Colposcopy with endocervical curettage. 41 0022: Fine needle aspiration (FNA); with imaging (non-palpable). 19000: Puncture aspiration of breast cyst; surgical procedure only. 19101: Biopsy of breast; open, incisional; not using imaging guidance. 19102: Biopsy with imaging guidance; percutaneous, needle core, using imaging guidance. 19103: Biopsy with imaging guidance; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance. 19290 Preoperative placement of needle localization wire, breast. 19291: Each additional lesion (used in conjunction with 19290 only). 588164: Pap Test reported TBS (Cytopathology, slides, cervical or vaginal - The Bethesda System); manual screening under physician supervision. 688142: Pap Test - Liquid Based (Thin Prep®) (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation). PAYABLE ONCE EVERY TWO YEARS PER CLIENT. 7See footnotes f and e. 8See footnote d. 919000: Puncture aspiration of breast cyst; surgical procedure only. 19101: Biopsy of breast; open, incisional; not using imaging guidance. 10See footnote d.