Department of Veterans' Affairs (DVA) Reason Codes
The following is a list of explanation codes used for veterans' treatment accounts processing. These codes provide information on the assessment of a claim, such as why a claim has been rejected. The codes are accompanied by a brief explanation. If you require further clarification of these codes, please contact Veterans' Affairs Processing on 1300 55 00 17.
| Code | Description |
| 101 | More details of service required to assess payment |
| 103 | Letter of explanation is being sent separately |
| 106 | Servicing Provider cannot be identified |
| 107 | Payment made on item other than that claimed |
| 108 | Item claimed not payable at date of service |
| 112 | Provider not an LMO - payment made at 85% of MBS fee |
| 113 | Total charge shown on voucher apportioned over all items |
| 115 | Payment recommended for this item |
| 117 | Payment not recommended for this item |
| 120 | Age restriction applies to this item (expired 01/01/2007) |
| 122 | Associated referral/request line not required |
| 123 | Payment made on radiology item other than service claimed |
| 124 | Item is restricted to persons of opposite sex to patient |
| 125 | Not payable without associated operation/anaesthetic item |
| 126 | Service is not payable without radiology service |
| 127 | Radiotherapy payment limited to five additional fields |
| 128 | Payment made on associated fracture/amputation item |
| 129 | Service is not payable without the base item/s |
| 130 | Letter of explanation is being sent separately (Refer to National Office for decision) |
| 131 | Return voucher |
| 134 | Single course of treatment paid as subsequent attendance |
| 135 | Provider not a consultant physician - specialist rate paid |
| 136 | Referral details not supplied - paid at GP rate |
| 138 | Item is only payable if self-determined or deemed necessary |
| 139 | Approved pathologist should not use this item number |
| 140 | Non-specialist provider |
| 141 | Provider not recognised to perform this service |
| 151 | Associated service already paid - adjustment being processed |
| 152 | Payment made on item other than that claimed (PSR) |
| 153 | Item claimed not payable at date of service (PSR) |
| 154 | Diagnostic Imaging Multiple Service Rule applied to service |
| 158 | Payment made on associated abandoned surgery/anae item |
| 159 | Item associated with other service which is payable |
| 160 | Maximum number of services for this item already paid |
| 162 | Service has been previously paid |
| 163 | Letter of explanation is being sent separately (Surgical/anaesthetic item/s already paid on this date) |
| 164 | Assistant surgeon service not payable |
| 168 | Not payable without associated operation/anaesthetic item |
| 169 | Letter of explanation is being sent separately (No operation/anaesthetic claimed) |
| 170 | Assistant anaesthetic service not payable |
| 171 | Service not payable - provider may only act in one capacity |
| 172 | Payment reduced - patient chose non-contracted hospital |
| 173 | Patient episode coning - maximum number of services paid |
| 174 | Patient episode coning adjustment |
| 175 | Payment made on associated foetal intervention item |
| 176 | Pay each foetal intervention item as a separate item |
| 177 | Foetal intervention item paid using derived fee item |
| 179 | Service not payable - associated service already paid |
| 180 | Payment declined - provider not elected as time-based |
| 182 | Payment made in accordance with time-based rules |
| 183 | Type C procedure claimed - only Band 1 accommodation payable |
| 184 | Payment made for additional time item using a derived fee |
| 186 | Type C procedure claimed - no theatre fee payable |
| 187 | No Type B/C certification present - payment declined |
| 194 | Letter of explanation is being sent separately (Provider under investigation - refer to supervisor) |
| 201 | Service not covered under current contract - contact DVA |
| 203 | Approval not sought by surgeon/admission advice not lodged |
| 204 | Item claimed does not attract GST |
| 207 | A separate charge must be supplied for this particular item |
| 211 | Patient not eligible at date of service |
| 212 | Date of service used is in the future |
| 213 | Upper or lower denture/jaw not specified for item claimed |
| 215 | Service claimed prior 1/1/84 |
| 222 | Payment made on associated anaesthetic item |
| 223 | Casting cost not payable - fee component in other item |
| 224 | Denture related item/s already paid within allowable period |
| 226 | Date of service prior to patients date of birth |
| 232 | Service claimed not payable in this instance |
| 233 | Provider not Local Medical Officer/Local Dental Officer |
| 238 | Travel allowance not payable in this instance |
| 249 | Please note Veteran's correct file number |
| 250 | Explanation/voucher will be forwarded separately |
| 251 | Requesting provider details not supplied |
| 252 | Service performed in aftercare period |
| 253 | Radiotherapy assessed with other item number on voucher |
| 254 | Assessment incomplete - further advice will follow |
| 256 | Service not payable for a hospital patient |
| 257 | Service already paid - no separate attendance evident on claim |
| 258 | Medicare benefits paid - no separate DVA attendance evident |
| 259 | Service being further considered |
| 260 | Benefit assessed with associated item on statement |
| 261 | Associated surgical items/anaesthetic time not supplied |
| 262 | Insufficient prolonged anaesthetic time - service not paid |
| 263 | Payment declined - only 1 claim allowed in claiming period |
| 267 | Service not payable - associated service not present |
| 271 | Not payable without associated ophthalmological item |
| 272 | Payment made on associated ophthalmological item |
| 275 | Provider not authorised to refer DVA patients |
| 276 | Service not commenced within specified time |
| 277 | Number of referrals issued exceeds prescribed limit |
| 278 | Referral not attached |
| 279 | DVA Prior approval not present – Contact DVA 1300 550 457 |
| 281 | Number of services claimed exceeds approved number |
| 282 | Date of service outside of approval/referral/request period |
| 283 | Item/condition claimed not covered by approval |
| 284 | Service requires referral - referral not provided |
| 285 | Prior Approval not sought for the provider/practice location |
| 286 | Service not an emergency |
| 287 | Approval incomplete - Contact DVA on 1300 550 457 |
| 288 | Fee paid in accordance with departmental agreed rates |
| 289 | Prior approval sought but not approved for this item |
| 290 | Item not payable in this state |
| 291 | Payment made at non-acute type rate |
| 292 | Gap payment made for hospital episode |
| 294 | Payment declined - no 3B certificate present |
| 295 | Leave days included in this account |
| 297 | Patient's name stated is different to that under file number |
| 298 | Reduced kilometres paid in this instance |
| 300 | Partial payment only - maximum dental limit reached |
| 301 | Payment declined - compensation/damages service |
| 302 | Prosthesis not paid - payment to be made by hospital |
| 304 | Service not payable in same period as physio/chiro treatment |
| 309 | Payment made for replacement of lost spectacles |
| 310 | Payment made for replacement of broken spectacles |
| 311 | Prescription change - payment for replacement of spectacles |
| 312 | Payment declined for replacement of lost spectacles |
| 313 | Payment declined for replacement of broken spectacles |
| 314 | No change in prescription evident - payment declined |
| 316 | Benefit not payable - item cannot be self-determined |
| 317 | Benefit not payable - additional item to those requested |
| 322 | Provider not approved for payment of this service |
| 325 | Laboratory not accredited for payment of this service |
| 326 | Laboratory not accredited at date of service |
| 328 | Payment made on associated tomography item |
| 329 | Not payable without associated tomography item |
| 330 | Payment made on pathology item at 85% of schedule fee |
| 332 | Category 5 lab - payment not made for requested service |
| 333 | Provider must claim time-based items |
| 336 | Fee paid on nuclear medicine item other than one claimed |
| 337 | Provider must claim content based items |
| 338 | Provider not registered to claim payments at date of service |
| 341 | No referral details - details required for future accounts |
| 342 | Referral expired - paid at non-specialist rate |
| 350 | Hospital referral - paid at specialist/consultant rate |
| 351 | Payment not made - LCC number not quoted or invalid |
| 352 | Service date outside LCC registration dates |
| 353 | Transaction fee not accompanied by pathology episode |
| 354 | Reduced bed fee - fee for outpatient service already paid |
| 355 | Payment made on pathology item - up to 100% of schedule fee |
| 356 | Classification change - new referral and admission date required |
| 357 | Admission and/or discharge date not supplied or invalid |
| 360 | Benefit not payable for requested services |
| 361 | DI exemption - items not approved |
| 362 | Payment made in accordance with recommended time limit |
| 364 | These items must be claimed under a combination item number |
| 370 | Payment made on item other than that claimed |
| 375 | Service being processed manually (EDI) |
| 376 | Patient cannot be identified from information supplied |
| 377 | Number of patients attended incomplete or incorrect. |
| 378 | Provider not registered to refer/request service at location |
| 379 | Claim Deleted - Contact Medicare eBusiness on 1800 700 199 |
| 390 | Documentation not received (EDI) |
| 391 | Service provider on D1217 differs from transmitted data (EDI) |
| 392 | Duplicate transmission - no further payment made (EDI) |
| 394 | Unable to identify service type and/or service dates (EDI) |
| 500 | Rejected in association with another item in this voucher |
| 504 | Charge keyed is incorrect or missing |
| 505 | More information required. Evidence of condition |
| 507 | Site not accredited for this service. |
| 509 | Service paid as item 2712 / 2719. |
| 510 | Service paid as item 52-96/or similar item. |
| 512 | Multiple Musculoskeletal MRI service rule applied |
| 513 | Multiple Musculoskeletal MRI and DI services rules applied |
| 514 | Required equipment type code not on LSPN register |
| 515 | Equipment greater than 10 years old |
| 516 | Benefit paid for base & derived radiotherapy items claimed |
| 526 | Item only attracts a benefit when claimed through Medicare |
| 528 | Provider not in eligible area (Incorrect RRMA, SSD or State) |
| 529 | No eligible associated service available for this veteran |
| 531 | Payment declined - DVA RCTI Agreement has not been signed |
| 532 | GST details incomplete - Phone DVA on 1300 550 457 |
| 533 | Claim referred to DVA - military compensation case |
| 534 | Claim referred to DVA for payment - any enquires to DVA |
| 536 | Location Specific Practice Number not Transmitted/Supplied |
| 537 | Location Specific Practice Number Invalid |
| 538 | Location Specific Practice Number not Recognised |
| 539 | Location Specific Practice Number not valid at Date of Service |
| 543 | Maximum payment already made for service/s claimed |
| 544 | Pharmacy/Disposables not payable under your contract |
| 545 | No charge or no cost items should not be shown on voucher |
| 546 | Invoice required for this item before payment can be made |
| 547 | DVA has advised that this service is not payable |
| 550 | Required Associated item not present for this veteran |
| 551 | Specimen Collection Point is incorrect or not supplied |
| 552 | Specimen Collection Point not valid at date of service |
| 553 | Approved Collection Centre number not supplied |
| 554 | Total Benefit for Anaesthetic Service |
| 555 | Payment made on Main RVG Anaesthetic Item |
| 556 | RVG Time Item Not Claimed |
| 557 | Associated RVG Anaesthetic Service Not Claimed |
| 558 | RVG Anaesthetic Item Not Claimed |
| 559 | Patient Outside Age Range For Item 25015 - Please Verify Age |
| 560 | RVG Item Restriction |
| 561 | Payment made on RVG Item Claimed |
| 562 | Payment made on Associated RVG Item |
| 563 | Associated RVG Service Already Paid |
| 564 | MVUSSR applied |
| 565 | DIMSR and MVUSSR applied |
| 566 | Total Benefit for Diagnostic Imaging Service |
| 567 | Benefit Paid on Main Diagnostic Imaging Service |
| 568 | Item cannot be substituted |
| 569 | Provider unable to substitute |
| 570 | The RPBC card can only be used to claim pharmaceuticals |
| 571 | Details transmitted differ from details on voucher |
| 572 | Prescription details not supplied or incomplete |
| 573 | Referring and servicing provider the same - no fee payable |
| 574 | Service voucher not received for this particular veteran |
| 575 | Date of service is after the date of lodgement |
| 576 | ICD 10 required before payment can be made |
| 577 | Clinical notes required before payment can be considered |
| 578 | Item number cannot be determined from information supplied |
| 579 | RVG items are not payable for DVA Time Based Anaesthetists |
| 580 | Treatment location and/or hospital name not stated |
| 581 | Condition treated has not been stated |
| 582 | Second provider in referral period - Please contact DVA |
| 583 | Service does not relate to Veterans specific condition/s |
| 584 | Anaesthetic start/finish time not indicated |
| 585 | Item claimed is inconsistent with Veterans age |
| 586 | Eye treated not stated on voucher/account |
| 587 | Living member dependants are not eligible for DVA payments |
| 588 | Service date after Veterans date of death recorded by DVA |
| 589 | Service not payable without associated Base or GST item |
| 590 | Service over 6 months old - DVA authorisation required |
| 591 | Payment made according to ICD code quoted |
| 592 | Prostheses paid in accordance with DVA agreed rates |
| 593 | Payment not yet authorised - contact DVA for resolution |
| 594 | Assistants fee to be claimed separately from surgeons fee |
| 595 | Payment for this item includes the casting component |
| 596 | Item paid has been changed as per advice from DVA |
| 597 | GST should not be included in the charge for the item |
| 598 | Tax invoice submitted – Payment made for service and GST |
| 599 | DVA Rural Incentives Loading is included in Payment |
| 600 | Provider requesting the service cannot be identified |
| 605 | Referral expired - no fee is payable |
| 606 | Referring provider practice location is closed |
| 607 | Referral date has been omitted |
| 608 | Referring and servicing provider the same - no fee payable |
| 609 | Service cancelled at providers request |
| 611 | Valid referral details not supplied - no fee is payable |
| 612 | Date of referral after date of service - no fee is payable |
| 614 | No Benefit payable - please notate time of each visit |
| 615 | Multiple procedures - notate times and area of treatment |
| 618 | Requesting provider not eligible to request this service |
| 622 | PET drop-down items not claimable via EDI |
| 624 | PET items-payee provider required |
| 625 | Payee provider not eligible to claim PET items |
| 627 | PDT statement NOT provided by the doctor |
| 629 | Initial PDT therapy item NOT present on patient history |
| 638 | Derived fee and other item cannot be claimed in-hospital |
| 639 | Provider not in an eligible area to claim this item |
| 640 | More than one base and derived item claimed |
| 641 | More than one base item claimed |
| 642 | Benefit paid for derived and other item claimed |
| 643 | Derived item assessed with other item on statement |
| 650 | Item MT98 not paid as date of service is prior to 1/1/2005 |
| 651 | MT98 not payable - Associated item not present or not paid |
| 652 | Service is after the discharge date for this referral period |
| 653 | Payment made on pathology item - up to 115% of schedule fee |
| 654 | Item transmitted via incorrect online claiming channel |
| 655 | Claim cannot be assessed without associated base or GST item |
| 656 | Claim cannot be assessed without upper/lower identified item |
| 657 | Date falls in gap between referrals - Please contact DVA |
| 658 | Payment made for replacement of lost dentures |
| 659 | Payment made for replacement of broken dentures |
| 660 | Prescriber details not supplied - no benefit is payable |
| 661 | Date of service falls outside approval/prescribing period |
| 662 | Referral/prescribing details incomplete or illegible |
| 663 | MT99 Not Payable - Associated item not present or not paid |
| 664 | LMO Supplementary Payment not made - Provider is not an LMO |
| 665 | Item MT99 not paid as Date of Service is prior to 7/6/2004 |
| 666 | Radiation Oncology equipment number invalid or not supplied |
| 667 | Service is over 5 years old - Further consideration required |
| 670 | Handling Fee Reduced according to Prostheses Amount Paid |
| 671 | Patient was in another Hospital prior to this admission |
| 672 | Patient was readmitted within 7 days of previous admission |
| 674 | Amendment/Adjustment- LMO Supplementary Payment also made |
| 690 | Surgical items not identified - Assistance item not paid |
| 691 | Surgeon cannot be identified - Assistance item not paid |
| 692 | DVA Incentive items only paid with LMO outpatient services |
| 693 | In this instance MT98 should be claimed |
| 694 | In this instance MT99 should be claimed |
| 695 | This item cannot be claimed as an 'Out of Hospital' service |
| 696 | This item cannot be claimed as an 'In Hospital' service |
| 697 | MT98/MT99 cannot be paid when DOS on or after 1 July 2007 |
| 732 | Referral period not valid for Referring Provider |
| 735 | Accommodation cannot span calendar year/contract end date |
| 736 | Payment Declined - No Contact Lens items in previous 3 years |
| 737 | Domiciliary item not payable without associated consultation |
| 741 | Inconsistent treatment location in vchr - claim separately |
| 742 | Assistant service does not match surgical items paid |
| 743 | Manual cheque being issued - cheque being sent separately. |
| 744 | Service not payable – Patient not eligible at date of service. |
| 745 | This PCC cardholder is ineligible for DVA treatment services. |
| 750 | Please re-transmit services in required order |
| 754 | This item cannot be paid for a DVA White Card holder |
| 759 | Item cannot be claimed until the last day of period of care |
| AMD | Amendment/adjustment to previously paid service |
| LWR | Lower denture - reline or tissue conditioning paid |
| UPR | Upper denture - reline or tissue conditioning paid |
| * | Amount payable includes GST (Manual Processing Only) |
Flag indicators:
A Identification Amended
C Veteran File Number Changed
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Last updated: 10 February, 2012