PBS Reason Codes Claims processing
New Streamlined Authority Number Initiative reason codes
From 1 April 2012 Medicare is introducing two new reason codes PDF's PBS Under co-payment for CTS and Online. Update of reason codes are as follows:
AMENDED REASON TYPE CODE from Warning (W) to Timed Warning (X)
- Reason Code 120 - Timed Warning (X)
- Reason Code 121 - Timed Warning (X)
- Reason Code 122 - Timed Warning (X)
AMENDED REASON TEXT - streamlined authority number is being change to streamlined authority code (Both Online claiming & CTS PDF's)
Reason Code 617 - Reject (R)
Reason Text : The streamlined authority code is invalid.
Reason Code 636 - Warning (W)
Reason Text : The streamlined authority code was not provided.
Reason Code 637 - Information (I)
Reason Text : A streamlined authority code is not required for this item.
Reason Code 639 - Reject (R)
Reason Text : The streamlined authority code provided does not match to the authority item.
- PBS reason codes for non-online pharmacies (CTS and paper-based) [PDF, 532Kb]
- PBS reason codes for online claiming for PBS pharmacies [PDF, 525Kb]
- PBS reason codes for under co payment (online) [PDF, 182Kb]
- PBS reason codes for under co payment (CTS) [PDF, 179Kb]
New Chemotherapy Initiative reason codes
From 1 December 2011 Medicare Australia is introducing one new Online Claiming for PBS reason code for PBS and RPBS - 656. The new reason code is required to identify the quantity supplied is greater than allowed for Chemotherapy items. The reason code will be implemented with an effective date of 1 December 2011.
Reason Code 656 (Reject) The quantity supplied is not allowed for this chemotherapy item – too many times the maximum amount has been supplied
Reason code 656 will be returned to pharmacy as a reject code. This message advises the pharmacist that the quantity supplied is greater than allowed for the chemotherapy item.
Some documents on this page may require the free Adobe PDF reader.
Last updated: 1 May, 2012