DVA reason codes
A list of reason codes used for Department of Veterans' Affairs (DVA) 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, contact the Veterans' Affairs Processing enquiry line.
Flag indicators
In a DVA Online claim, the following flag indicators tell you when client details have been changed:
- A = Identification Amended
- C = Veteran File Number Changed
Reason 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 | Maximum number of additional fields already paid |
128 | Payment made on associated fracture/amputation item |
129 | Service is not payable without the base item/s |
130 | Referred to National Office for decision |
131 | Date of service not supplied/invalid |
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 |
137 | Details of requesting provider not shown on voucher |
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 or unbanded 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 |
206 | Item number does not attract a benefit at date of service |
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 |
217 | Patient cannot be identified from information supplied |
222 | Payment made on associated anaesthetic item |
223 | Service not payable – specified items not claimed/present |
224 | Denture related item/s already paid within allowable period |
226 | Unable to identify service date/s |
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 in a manual claim |
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 |
266 | Prior approval needed for convalescent care over 21 days |
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 1800 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 1800 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 |
293 | Not eligible for NHTP |
294 | Payment declined - no acute care 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 |
335 | Service is not payable without nuclear medicine service |
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) |
438 | Consultation and DI item/s not payable on same day |
439 | Requesting provider not in an eligible geographic location |
451 | Service provided in an ineligible location |
500 | Rejected in association with another item in this voucher |
502 | Patient is not eligible to claim benefit for this item |
504 | Charge keyed is incorrect or missing |
505 | Condition treated or distance travelled required |
506 | Consultation not payable on same day as surgical procedure |
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 is older than allowable age for this item |
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 - Phone GST Team on 1800 653 629 |
532 | GST details incomplete - Phone GST Team on 1800 653 629 |
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 |
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 | Hospital name required when treatment provided in hospital |
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 | Date of service over 2 years - Late Lodgement Form 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 or invalid |
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 |
621 | Item not claimable electronically |
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 | Provider not an LMO. Call DVA on 1800 550 457 for review |
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 |
668 | Item MT99 paid- associated item is not Level A consultation |
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 |
675 | Item MT98 is payable for MBS Level A consultation items |
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 |
746 | MBS equivalent or item description must be stated in text |
747 | Item included in theatre fees |
750 | Please re-transmit services in required order |
751 | Workforce Supplement Payment |
752 | No GST paid - Norfolk Island rendered service |
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) |
Page last updated: 28 May 2020
This information was printed 13 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/topics/dva-reason-codes/31966. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.