Medicare codes on claims | RebateRight

Medicare returns a 4-digit code for each problem it finds in a claim, with a message that names the field, the medical event and the service. This page gives the meaning of the common claim codes and what to do about each one. Each meaning is shortened from Services Australia’s list of Medicare Online and ECLIPSE return codes.

Catch many before you claim. RebateRight’s Eligibility Check flags the problems marked below before the claim goes in, when you send the details you will claim with.

Values and structure

Code	Medicare’s meaning	What to do
`2025`	The claim has reached the maximum number of entries of one kind, such as medical events.	Split the claim. Each claim type’s page gives its limits, such as bulk bill and patient claims.
`2030`	A value conflicts with another value in the claim, or a value needs a related value that is missing.	Read the `reason`, which states the rule, and correct the claim.
`2032`	A voucher (medical event) has reached the maximum number of services.	Split the medical event.
`2033`	The claim has reached the maximum number of services.	Split the claim.
`9201`	A value is in the wrong format.	Correct the field that the `reason` names.
`9202`	A value is not one Medicare permits, or it failed a check-digit check. Many different `reason` messages share this code.	Correct the field that the `reason` names. Before you claim, send the details to the Eligibility Check, which flags a Medicare card number, IRN or provider number that fails these checks.
`9203`	The date of service is more than 6 months in the past.	Check the date of service. Each claim type’s page gives its claim age rule, such as bulk bill.
`9204`	A date is in the future.	Correct the date.
`9210`	The date of service is more than 2 years in the past.	Check the date of service. Each claim type’s page gives its claim age rule, such as bulk bill.
`9644`	The claim mixes in-hospital and out-of-hospital services.	Send in-hospital and out-of-hospital services in separate claims.
`9776`	The request has more than 500 transactions.	Send no more than 500 transactions in one request.

Items and services

Code	Medicare’s meaning	What to do
`9607`	The item may be claimed only as a bulk bill.	Send the service in a bulk bill claim. Flagged by the Eligibility Check
`9611`	The item is unknown, or is not valid on the date of service.	Check the item number in the MBS for the date of service. Flagged by the Eligibility Check
`9613`	The service cannot be performed in hospital.	Check the item and `hospitalInd`. Flagged by the Eligibility Check
`9617`	The referral has expired.	Send the details of a current referral.
`9618`	The charge is missing or not a valid amount.	Send a valid `chargeAmount`.
`9621`	The practitioner cannot self-deem this pathology, diagnostic imaging or specialist service.	Send the referral or request details instead of `selfDeemedCode`.
`9622`	The attendance item needs the number of patients seen.	Send `numberOfPatientsSeen` with the service.
`9628`	The service needs a referral or a request.	Send the referral or request details. Flagged by the Eligibility Check
`9637`	Medicare needs more information, such as service text, to support the service.	Send service `text` that supports the service.
`9700`	The item number looks wrong, or the amount claimed does not match the item.	Check the item number and the amount claimed.
`9709`	An age restriction applies to the item.	Check the item’s age rules in the MBS. Flagged by the Eligibility Check

Duplicates and frequency

Code	Medicare’s meaning	What to do
`9632`	The service duplicates one already paid.	If the service is not a duplicate, send it again with `duplicateServiceOverrideInd` set to `Y`. Flagged by the Eligibility Check
`9701`	Medicare has paid the maximum number of services for the item.	If the service is not a duplicate, send it again with the correct item numbers from the MBS. Flagged by the Eligibility Check
`9704`	The service appears to have been claimed before.	Contact Medicare to discuss the claim. Flagged by the Eligibility Check
`9775`	The `correlationId` is not valid, or Medicare cannot find it.	Check that you sent the original claim’s `correlationId`.
`9777`	Medicare already holds a claim with this `correlationId`.	Follow 9777 in Errors and retries, which tells a resend apart from a reused ID.

Patients and providers

Code	Medicare’s meaning	What to do
`9605`	The patient may have a new Medicare card, or the details do not match Medicare’s.	Check the patient’s card details, update your records and send the claim again. Flagged by the Eligibility Check
`9626`	The patient is or was covered under a Reciprocal Health Care Agreement.	Check the patient’s cover, as Reciprocal Medicare cardholders explains. Flagged by the Eligibility Check
`9635`	The servicing provider may not be able to provide this item on the date of service.	Check the servicing provider number, and that the provider may render the item on that date. Flagged by Servicing Provider Eligibility
`9636`	Medicare asks you to check the payee provider.	Check `payeeProvider`, as Who gets paid explains.
`9649`	Medicare cannot determine the patient’s eligibility.	Check the patient’s Medicare details before you claim again. Flagged by the Eligibility Check

Authorisation and channel

Code	Medicare’s meaning	What to do
`9001`	The location is not authorised for online claiming.	Call the Medicare eBusiness Service Centre on 1800 700 199. Register a clinic for claiming gives the steps.
`9002`	The person signing the claim is not authorised for online claiming.	Call the Medicare eBusiness Service Centre on 1800 700 199.
`9006`	The provider is not authorised for online claiming.	Call the Medicare eBusiness Service Centre on 1800 700 199.
`9010`	The software is not certified for this function.	Call the Medicare eBusiness Service Centre on 1800 700 199, and email hello@rebateright.com.au with the claim’s `correlationId`.
`9602`	The claim cannot be lodged through this channel.	Lodge the claim through another Medicare claiming channel.

Assessment and payment

Code	Medicare’s meaning	What to do
`3004`	Medicare’s real-time processing is not available, or its system is down.	Follow 3004 in Errors and retries, which tells the daily limit apart from a system error.
`9601`	Medicare has pended the claim for assessment by an officer.	There is nothing to send. Medicare tells the claimant the outcome by mail.
`9640`	Medicare found no errors, but the benefit is above its review threshold, so an operator must review the claim.	When the claim comes back `MEDICARE_PENDABLE`, follow Pendable claims.
`9707`	The claim needs assessment by a Medicare officer.	Give the claimant an account or receipt, so they can claim through another Medicare channel.
`9783`	The claimant needs to update their bank details with Medicare.	Follow No valid bank details.

Same day delete

Code	Medicare’s meaning	What to do
`9645`	The claim is not in a state that can be deleted.	Delete only a claim with status `MEDICARE_ASSESSED`.
`9646`	Medicare cannot find the claim.	Check that the request identifies the original claim.
`9647`	Medicare has already deleted the claim.	Nothing more is needed.
`9648`	The reason code for the delete is missing or not valid.	Send a `reasonCode` from `001` to `007`.

Where the code appears

Response	Where to read it	What it means for the claim
`400` from any claim endpoint	`serviceMessage[].code` and `serviceMessage[].reason`	Medicare rejected the entire claim, and nothing is lodged. Correct it and send it with a new `correlationId`, as Correlation ID explains.
`200` from an interactive patient claim	`claimAssessment.error`, or a service’s `error.code` and `error.text`	Medicare assessed the claim. The `status` says whether it was assessed, pendable or rejected.
A processing report	A service’s `assessmentCode`	Medicare gives a 3-digit reason code. Look it up in Medicare reason codes (Services Australia).

Read the message first. Medicare’s reason or text names the field and the rule, so it is more specific than the meanings on this page. Show it to your user exactly as Medicare returns it.

Every other code

Services Australia publishes the full lists:

Medicare Online and ECLIPSE return codes, the 4-digit codes, also as a CSV file to load into your software.
Medicare reason codes, the 3-digit codes on processing reports and statements.

For the codes on a patient check, such as a patient verification or a health fund check, see Medicare codes on patient checks.

For a code that comes from RebateRight rather than Medicare, such as a 401 or a 503, see Errors and retries.