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 Department of Veterans' Affairs processing centre.

Flag indicators

  • 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 Radiotherapy payment limited to five additional fields
128 Payment made on associated fracture/amputation item
129 Service is not payable without the base item/s
130 Letter of explanation is being sent separately (Refer to National Office for decision)
131 Return voucher
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
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 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
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
222 Payment made on associated anaesthetic item
223 Casting cost not payable - fee component in other item
224 Denture related item/s already paid within allowable period
226 Date of service prior to patients date of birth
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
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
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 1300 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 1300 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
294 Payment declined - no 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
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)
500 Rejected in association with another item in this voucher
504 Charge keyed is incorrect or missing
505 More information required. Evidence of condition
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 greater than 10 years old
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
532 GST details incomplete - Phone DVA on 1300 550 457
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
566 Total Benefit for Diagnostic Imaging Service
567 Benefit Paid on Main Diagnostic Imaging Service
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 Treatment location and/or hospital name not stated
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 Service over 6 months old - DVA authorisation 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
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
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 LMO Supplementary Payment not made - Provider is not an LMO
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
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
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.
750 Please re-transmit services in required order
751 Workforce Supplement Payment
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: 21 July 2016

This information was printed Monday 5 December 2016 from humanservices.gov.au/health-professionals/enablers/dva-reason-codes It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.