PBS Reason Codes
PBS reason codes can be loaded for use in your programs. These codes describe what has happened during the assessment of a PBS claim.
PBS reason codes are available as an Excel spreadsheet which is password protected. Pharmacy Dispensing Software vendors are supplied with the password.
Important: the PBS reason codes (CSV) [ZIP, 39KB] is updated monthly, as required.
If you require further clarification of these reason codes, please phone Medicare Australia on 132 290 (call charges may apply) and select option 2.
Reason code acronyms
| Column name | Values | Meanings | Description |
|---|---|---|---|
| Channel code | D | ‘D’ – Default | Indicates which channel the fix instructions are designed for |
| B | ‘B’ – B2B | ||
| Reason type code | R | ‘R’ – Reject | Reject (Do not send paperwork for online claims) |
| X | ‘X’- Time (warn then reject) | Time based Warning - Returned as a Warning (W) for a set period of time. After this time the reason code will be returned as a Reject (R). | |
| W | ‘W’- Warning | Warning | |
| Claimant Processing code | Numeric 00-99 | 00 - Default | |
| 02 - ISP down | Code supplied by pharmacy software to indicate a connection problem with Medicare Australia | ||
| Reason text | 120 Characters | Reason code message | |
| Fix instructions | 3000 Characters | How to fix the problem | |
| Contact details | 300 Characters | Who to contact for info/help |
Last updated: 25 June, 2012