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MA20 Remark Code: SNF Stay for Catheter Care Not Covered

MA20 means the skilled nursing facility (SNF) stay is not covered because the care was primarily related to using a urethral catheter for convenience or to control incontinence. That care alone does not meet the need for skilled services the SNF benefit requires.

Quick facts

Code
MA20 (RARC MA20)
Status
Active In use since January 1, 1997; last modified June 30, 2003.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The facility is responsible unless a valid advance notice of non-coverage was given to the patient.
  • PR (Patient Responsibility): The patient may be responsible if they received proper advance notice that the stay might not be covered.
Official description
Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA20 means

Medicare’s SNF benefit covers stays only when the patient needs skilled nursing or rehabilitation services on a daily basis. MA20 is a specific finding that the care provided was mainly about a urethral catheter used for convenience or to manage incontinence. Under the code’s wording, that kind of care does not justify a covered SNF stay.

This code comes from institutional claims. It usually appears with a medical necessity or non-covered reason code.

Common causes

  • The documentation focused on catheter care without describing other skilled needs.
  • The patient’s condition had stabilised and remaining care was custodial.
  • Diagnosis coding emphasised incontinence rather than the condition that required skilled care.

How to fix it

  1. Review the record. Identify whether the patient received skilled nursing or therapy services beyond catheter management.
  2. Check coding. Make sure the principal diagnosis reflects the condition that required skilled care.
  3. Correct and resubmit if the claim was coded incorrectly, following the payer’s rules for adjustment bills.
  4. Appeal with clinical detail if skilled services were provided and documented.
  5. Check notice requirements before billing the patient.

How to prevent it

Document the specific skilled services and why they need a licensed professional, and review coverage when the patient’s skilled needs decrease. Denials rooted in documentation are discussed in how to analyze CARC and RARC denials.

Codes that may appear with MA20

  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): A medical necessity denial, reflecting that the stay did not require skilled care.
  • CO-96 (Non-covered charge(s).): The stay is treated as a non-covered charge.
  • CO-190 (Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.): Payment is included in the allowance for a qualified SNF stay, a bundling issue rather than a coverage denial.
  • MA24 (Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.): A Christian Science sanitarium or SNF bill in the same benefit period.
  • CO-A6 (Prior hospitalization or 30 day transfer requirement not met.): The prior hospitalization or 30-day transfer requirement was not met.

MA20 FAQ

Is catheter care ever a skilled service?

Catheter care can be part of a skilled need, for example when there are complications or when it is combined with other skilled services. MA20 applies when catheter use for convenience or incontinence was the main reason for the stay.

Can I appeal MA20?

Yes, if the medical record shows the patient needed daily skilled services beyond catheter management. The appeal should point to those specific services.

Who pays if the stay is not covered?

It depends on whether the patient received a valid advance notice of non-coverage. Without it, the facility generally bears the cost.