Top Claim Submission Errors for Hospice Providers: Error 31428
Reason for error: The claim contains a hospice discipline revenue code (42X, 43X, 44X, 55X, 56X, or 57X) and is either missing or has an incorrect corresponding HCPCS code (G0151, G0152, G0153, G0155, G0156, G0299 or G0300).
Claim processing result: Return to Provider (RTP)
How to prevent/resolve:
- Ensure that your claim contains the appropriate HCPCS code on the discipline
revenue code line.
Revenue Code (Discipline)
HCPCS
042X (Physical therapy)
G0151
043X (Occupational therapy)
G0152
044X (Speech-language pathology)
G0153
055X (Skilled nursing)
G0299 (valid for services on or after January 1, 2016)
G0300 (valid for services on or after January 1, 2016)
G0154 (not valid for services on or after January 1, 2016)
056X (Medical social services)
G0155
057X (Aide)
G0156
- Ensure that the HCPCS code is keyed using a "0" (number zero); not an "O" (letter O).
- Ensure that the HCPCS code begins with the letter "G"; not the letter "Q".
Additional resource:
- Hospice Medicare Billing Codes Sheet quick resource tool
- Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, §30.3
Updated: 05.20.19