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Linda Collins Blogger

Claim Adjustment Reason Code 223 Explained

Posted by Linda Collins | July 16, 2013

CARC 223 states:

"Adjustment code for mandated Federal, State or local law/regulation that is not already covered by another code and is mandated before a new code can be created."

What does it mean?

You can blame the politicians for the most frequent reason this code appears on your Electronic Remittance Advice form. Due to the government sequestration effective April 1, 2013, Medicare had to enact an automatic 2% reduction in final payments. (See April 1, 2013 post “2% Less.”)

As a result, Medicare FFS claims with dates of service on or after April 1, 2013, incur this 2%reduction. Suppliers will see the code 223 on the line level along with the amount of reduction.

Medicare applies the adjustments after determining the Medicare payment, including application of the current fee schedule, coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. The Medicare fee schedule is unchanged; it's only the final payment amount that is reduced.

The sequestration order covers all payments for services with dates of service April 1, 2013, through March 31, 2014.

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