What's new?

July 2014

Improvements will be made to the way some PBS medicines are processed under the Highly Specialised Drugs Programme from 1 July 2015.

Medicare reason codes

The following is a list of explanation codes currently in use by Medicare Programs. These codes describe what has happened during assessing of a claim for Medicare benefits. These codes are accompanied by a brief explanation of what the code means. If you require further clarification of these codes, please phone 132 011 (general public), or 132 150 (providers only).

Where an @ symbol appears on a statement of benefits it means the card number quoted on the claim has been changed to reflect the current card issue number.

Download Medicare reason codes

The Medicare Reason codes can be downloaded for use in your programs. Reason codes are availalable in a CSV (Comma Separated Values) format. The file is compressed in ZIP format. There are many tools which can be used for manipulating ZIP files such as Alladin Expander free for Microsoft Windows and Apple Macintosh, and non-free (Alladin Stuffit) for Linux and Sun Solaris. WinZip (for Microsoft Windows), currently a shareware product. InfoZip (for many platforms).

The ZIP contains one file, a CSV file, which is a variable width record. This is a file format which can be opened by a number of products on personal computers, including Microsoft Excel. The file format is "numeric","text" where: numeric = reason code number, text = short descriptive text. No column headings are included.

Last updated: 3 May, 2012