Look up a DVA reason code

Reason codes for Department of Veterans' Affairs (DVA) claims.

A DVA reason code gives you information about the outcome of a claim.

The following table contains reason codes and their descriptions. Enter the reason code in the filter box below to search for the results of a claim.

Read more about rejected DVA claims if you need further information about the assessment of a DVA claim.

Use the filter box. Enter the code or keywords from the reason code message.

Reason codeDescription
101More details of service required to assess payment.
103Letter of explanation is being sent separately.
106Servicing Provider cannot be identified.
107Payment made on item other than that claimed.
108Item claimed not payable at date of service.
112Provider not a LMO - payment made at 85% of MBS fee.
113Total charge shown on voucher apportioned over all items.
115Payment recommended for this item.
117Payment not recommended for this item.
120Age restriction applies to this item (expired 01/01/2007).
122Associated referral/request line not required.
123Payment made on radiology item other than service claimed.
124Item is restricted to persons of opposite sex to patient.
125Not payable without associated operation/anaesthetic item.
126Service is not payable without radiology service.
127Maximum number of additional fields already paid.
128Payment made on associated fracture/amputation item.
129Service is not payable without the base item/s.
130Referred to National Office for decision.
131Date of service not supplied/invalid.
134Single course of treatment paid as subsequent attendance.
135Provider not a consultant physician - specialist rate paid.
136Referral details not supplied - GP rate.
137Details of requesting provider not shown on voucher.
138Item is only payable if self-determined or deemed necessary.
139Approved pathologist should not use this item number.
140Non-specialist provider.
141Provider not recognised to perform this service.
151Associated service already paid - adjustment being processed.
152Payment made on item other than that claimed (PSR).
153Item claimed not payable at date of service (PSR).
154Diagnostic Imaging Multiple Service Rule applied to service.
158Payment made on associated abandoned surgery/anae item.
159Item associated with other service which is payable.
160Maximum number of services for this item already paid.
162Service has been previously paid.
163Letter of explanation is being sent separately (Surgical/anaesthetic item/s already paid on this date).
164Assistant surgeon service not payable.
168Not payable without associated operation/anaesthetic item.
169Letter of explanation is being sent separately (No operation/anaesthetic claimed).
170Assistant anaesthetic service not payable.
171Service not payable - provider may only act in one capacity.
172Payment reduced - patient chose non-contracted hospital.
173Patient episode coning - maximum number of services paid.
174Patient episode coning adjustment.
175Payment made on associated foetal intervention item.
176Pay each foetal intervention item as a separate item.
177Foetal intervention item paid using derived fee item.
179Service not payable - associated service already paid.
180Payment declined - provider not elected as time-based.
182Payment made in accordance with time-based rules.
183Type C procedure claimed - only Band 1 accommodation payable.
184Payment made for additional time item using a derived fee.
186Type C or unbranded procedure claimed - no theatre fee payable.
187No Type B/C certification present - payment declined.
194Letter of explanation is being sent separately (Provider under investigation - refer to supervisor).
201Service not covered under current contract – contact DVA
203Approval not sought by surgeon/admission advice not lodged.
204Item claimed does not attract GST.
206Item number does not attract a benefit at date of service.
207A separate charge must be supplied for this particular item.
211Patient not eligible at date of service.
212Date of service used is in the future.
213Upper or lower denture/jaw not specified for item claimed.
215Service claimed prior 1/1/84.
217Patient cannot be identified from information supplied.
222Payment made on associated anaesthetic item.
223Service not payable - specified items not claimed/present.
224Denture related item/s already paid within allowable period.
226Unable to identify service date/s.
232Service claimed not payable in this instance.
233Provider not Local Medical Officer/Local Dental Officer.
238Travel allowance not payable in this instance.
249Please note Veteran's correct file number.
250Explanation/voucher will be forwarded separately.
251Requesting provider details not supplied.
252Service performed in aftercare period.
253Radiotherapy assessed with other item number on voucher.
254Assessment incomplete - further advice will follow.
256Service not payable for a hospital patient.
257Service already paid - no separate attendance evident on claim.
258Medicare benefits paid - no separate DVA attendance evident.
259Service being further considered in a manual claim.
260Benefit assessed with associated item on statement.
261Associated surgical items/anaesthetic time not supplied.
262Insufficient prolonged anaesthetic time - service not paid.
263Payment declined - only 1 claim allowed in claiming period.
266Prior approval needed for convalescent care over 21 days.
267Service not payable - associated service not present.
271Not payable without associated ophthalmological item.
272Payment made on associated ophthalmological item.
275Provider not authorised to refer DVA patients.
276Service not commenced within specified time.
277Number of referrals issued exceeds prescribed limit.
278Referral not attached.
279DVA Prior approval not present – Contact DVA 1800 550 457.
281Number of services claimed exceeds approved number.
282Date of service outside of approval/referral/request period.
283Item/condition claimed not covered by approval.
284Service requires referral - referral not provided.
285Prior Approval not sought for the provider/practice location.
286Service not an emergency.
287Approval incomplete – Contact DVA on 1800 550 457.
288Fee paid in accordance with departmental agreed rates.
289Prior approval sought but not approved for this item.
290Item not payable in this state.
291Payment made at non-acute type rate.
292Gap payment made for hospital episode.
293Not eligible for NHTP.
294Payment declined - no acute care 3B certificate present.
295Leave days included in this account.
297Patient's name stated is different to that under file number.
298Reduced kilometres paid in this instance.
300Partial payment only - maximum dental limit reached.
301Payment declined - compensation/damages service.
302Prosthesis not paid - payment to be made by hospital.
304Service not payable in same period as physio/chiro treatment.
309Payment made for replacement of lost spectacles.
310Payment made for replacement of broken spectacles.
311Prescription change - payment for replacement of spectacles.
312Payment declined for replacement of lost spectacles.
313Payment declined for replacement of broken spectacles.
314No change in prescription evident - payment declined.
316Benefit not payable - item cannot be self-determined.
317Benefit not payable - additional item to those requested.
322Provider not approved for payment of this service.
325Laboratory not accredited for payment of this service.
326Laboratory not accredited at date of service.
328Payment made on associated tomography item.
329Not payable without associated tomography item.
330Payment made on pathology item at 85% of schedule fee.
332Category 5 lab - payment not made for requested service.
333Provider must claim content based items.
335Service is not payable without nuclear medicine service.
336Fee paid on nuclear medicine item other than one claimed.
337Provider must claim content-based items.
338Provider not registered to claim payments at date of service.
341No referral details - details required for future accounts.
342Referral expired - paid at non-specialist rate.
350Hospital referral - paid at specialist/consultant rate.
351Payment not made - LCC number not quoted or invalid.
352Service date outside LCC registration dates.
353Transaction fee not accompanied by pathology episode.
354Reduced bed fee - fee for outpatient service already paid.
355Payment made on pathology item - up to 100% of schedule fee.
356Classification change - new referral and admission date required.
357Admission and/or discharge date not supplied or invalid.
360Benefit not payable for requested services.
361DI exemption - items not approved.
362Payment made in accordance with recommended time limit.
364These items must be claimed under a combination item number.
370Payment made on item other than that claimed.
375Service being processed manually EDI.
376Patient cannot be identified from information supplied.
377Number of patients attended incomplete or incorrect.
378Provider not registered to refer/request service at location.
379Claim deleted – Contact Medicare eBusiness on 1800 700 199.
390Documentation not received EDI.
391Service provider on D1217 differs from transmitted data EDI.
392Duplicate transmission - no further payment made EDI.
394Unable to identify service type and/or service dates EDI.
438Consultation and DI item/s not payable on same day.
439Requesting provider not in an eligible geographic location.
442Patient not MyMedicare registered with provider/practice.
443Patient MyMedicare registered with another provider/practice.
451Service provided in an ineligible location.
500Rejected in association with another item in this voucher.
502Patient is not eligible to claim benefit for this item.
504Charge keyed is incorrect or missing.
505Condition treated or distance travelled required.
506Consultation not payable on same day as surgical procedure.
507Site not accredited for this service.
509Service paid as item 2712 / 2719.
510Service paid as item 52-96 or similar item.
512Multiple Musculoskeletal MRI service rule applied.
513Multiple Musculoskeletal MRI and DI services rules applied.
514Required equipment type code not on LSPN.
515Equipment is older than allowable age for this item.
516Benefit paid for base & derived radiotherapy items claimed.
526Item only attracts a benefit when claimed through Medicare.
528Provider not in eligible area (Incorrect RRMA, SSD or State).
529No eligible associated service available for this veteran.
531Payment declined - DVA RCTI Agreement has not been signed. Phone GST Team on 1800 653 629.
532GST details incomplete. Phone GST Team on 1800 653 629.
533Claim referred to DVA - military compensation case.
534Claim referred to DVA for payment – any enquiries to DVA.
536Location Specific Practice Number not transmitted/supplied.
537Location Specific Practice Number invalid.
538Location Specific Practice Number not recognised.
539Location Specific Practice Number not valid at Date of service.
543Maximum payment already made for service/s claimed.
544Pharmacy/Disposables not payable under your contract.
545No charge or no cost items should not be shown on voucher.
546Invoice required for this item before payment can be made.
547DVA has advised that this service is not payable.
550Required Associated item not present for this veteran.
551Specimen Collection Point is incorrect or not supplied.
552Specimen Collection Point not valid at date of service.
553Approved Collection Centre number not supplied.
554Total Benefit for Anaesthetic Service.
555Payment made on main RVG Anaesthetic Item.
556RVG Time Item Not Claimed.
557Associated RVG Anaesthetic Service Not Claimed.
558RVG Anaesthetic Item Not Claimed.
559Patient Outside Age Range for Item 25015 – Please Verify Age.
560RVG Item Restriction.
561Payment made on RVG Item Claimed.
562Payment made on Associated RVG Item.
563Associated RVG Service Already Paid.
564MVUSSR applied.
565DIMSR and MVUSSR applied.
568Item cannot be substituted.
569Provider unable to substitute.
570The RPBC can only be used to claim pharmaceuticals.
571Details transmitted differ from details on voucher.
572Prescription details not supplied or incomplete.
573Referring and servicing provider the same - no fee payable.
574Service voucher not received for this particular veteran.
575Date of service is after the date of lodgement.
576ICD 10 required before payment can be made.
577Clinical notes required before payment can be considered.
578Item number cannot be determined from information supplied.
579RVG items are not payable for DVA Time-Based Anaesthetists.
580Hospital name required when treatment provided in hospital.
581Condition treated has not been stated.
582Second provider in referral period. Please contact DVA.
583Service does not relate to Veterans specific condition/s.
584Anaesthetic start/finish time not indicated.
585Item claimed is inconsistent with Veteran’s age.
586Eye treated not stated on voucher/account.
587Living member dependants are not eligible for DVA payments.
588Service date after Veteran’s date of death recorded by DVA.
589Service not payable without associated Base or GST item.
590Date of service over 2 years - Late Lodgement Form required.
591Payment made according to ICD code quoted.
592Prostheses paid in accordance with DVA agreed rates.
593Payment not yet authorized. Contact DVA for resolution.
594Assistants fee to be claimed separately from surgeon’s fee.
595Payment for this item includes the casting component.
596Item paid has been changed as per advice from DVA.
597GST should not be included in the charge for the item.
598Tax invoice submitted - Payment made for service and GST.
599DVA Rural Incentives Loading is included in Payment.
600Provider requesting the service cannot be identified.
605Referral expired - no fee is payable.
606Referring provider practice location is closed.
607Referral date has been omitted or invalid.
608Referring and servicing provider the same - no fee payable.
609Service cancelled at providers request.
611Valid referral details not supplied - no fee is payable.
612Date of referral after date of service - no fee is payable.
614No Benefit payable - please notate time of each visit.
615Multiple procedures - notate times and area of treatment.
618Requesting provider not eligible to request this service.
621Item not claimable electronically.
622PET drop-down items not claimable via EDI.
624PET items - payee provider required.
625Payee provider not eligible to claim PET items.
627PDT statement NOT provided by the doctor.
629Initial PDT therapy item NOT present on patient history.
638Derived fee and other item cannot be claimed in-hospital.
639Provider not in an eligible area to claim this item.
640More than one base and derived item claimed.
641More than one base item claimed.
642Benefit paid for derived and other item claimed.
643Derived item assessed with other item on statement.
650Item MT98 not paid as date of service is prior to 1/1/2005.
651MT98 not payable - Associated item not present or not paid.
652Service is after the discharge date for this referral period.
653Payment made on pathology item - up to 115% of schedule fee.
654Item transmitted via incorrect online claiming channel.
655Claim cannot be assessed without associated base or GST item.
656Claim cannot be assessed without upper/lower identified item.
657Date falls in gap between referrals. Please contact DVA.
658Payment made for replacement of lost dentures.
659Payment made for replacement of broken dentures.
660Prescriber details not supplied - no benefit is payable.
661Date of service falls outside approval/prescribing period.
662Referral/prescribing details incomplete or illegible.
663MT99 Not Payable - Associated item not present or not paid.
664Provider not an LMO. Call DVA on 1800 550 457 for review.
665Item MT99 not paid as Date of Service is prior to 7/6/2004.
666Radiation Oncology equipment number invalid or not supplied.
667Service is over 5 years old - Further consideration required.
668Item MT99 paid - associated item is not Level A consultation.
670Handling Fee Reduced according to Prostheses Amount Paid.
671Patient was in another Hospital prior to this admission.
672Patient was readmitted within 7 days of previous admission.
674Amendment/Adjustment -LMO Supplementary Payment also made.
675Item MT98 is payable for MBS Level A consultation items.
690Surgical items not identified - assistance item not paid.
691Surgeon cannot be identified - assistance item not paid.
692DVA Incentive items only paid with LMO outpatient services.
693In this instance MT98 should be claimed.
694In this instance MT99 should be claimed.
695This item cannot be claimed as an ‘Out of Hospital’ service.
696This item cannot be claimed as an ‘In hospital’ service.
697MT98/MT99 cannot be paid when DOS on or after 1 July 2007.
732Referral period not valid for Referring Provider.
735Accommodation cannot span calendar year/contract end date.
736Payment Declined - No Contact Lens items in previous 3 years.
737Domiciliary item not payable without associated consultation.
741Inconsistent treatment location in vchr - claim separately.
742Assistant service does not match surgical items paid.
743Manual cheque being issued - cheque being sent separately.
744Service not payable - Patient not eligible at date of service.
745The PCC cardholder is ineligible for DVA treatment services.
746MBS equivalent or item description must be stated in text.
747Item included in theatre fees.
748Initial consultation for treatment cycle is not present.
750Please re-transmit services in required order.
751Workforce Supplement Payment.
752No GST paid - Norfolk Island rendered service.
754This item cannot be paid for a DVA White Card holder.
759Item cannot be claimed until the last day of period of care.
AMDAmendment/adjustment to previously paid service.
LWRLower denture - reline or tissue conditioning paid.
UPRUpper denture - reline or tissue conditioning paid.
*Amount payable includes GST (Manual Processing Only).
Page last updated: 15 June 2024.
QC 74049