License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

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CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

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The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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February 17, 2020

Reason Code 37253 and the OASIS Assessment

Submission of an Outcome and Assessment Information Set (OASIS) is a condition of payment for home health periods of care. OASIS reporting regulations require the OASIS to be transmitted within 30 days of completing the assessment of the beneficiary.

If the OASIS assessment is not found in the Internet Quality Improvement and Evaluation System (iQIES) system when your final claim is submitted, and the receipt date of the claim is more than 40 days after the assessment completion date, Medicare systems will apply reason code 37253 to the claim and it will be sent to the Return to Provider (RTP) file.

How to Prevent 37253

Before submitting your claim and the OASIS assessment, ensure the following OASIS items are correct. These items are used to match the claim with the OASIS assessment.

Home health agency (HHA) Certification Number (OASIS item M0010)
Beneficiary Medicare Number (OASIS item M0063)
Assessment Completion Date (OASIS item M0090)
Reason for Assessment (OASIS Item M0100) equal to 01, 03, or 04

Note: Effective January 1, 2020, all claims must be submitted with the beneficiary's Medicare Beneficiary Identifier (MBI), regardless of the dates of service. Therefore, it is important to report the MBI on your OASIS.

If Your Claim Is in RTP (Status/Location T B9997)

Review the OASIS and claim and correct any errors to ensure they match and then resubmit (F9) the claim out of the RTP file.

It is important that you verify that the OASIS was successfully accepted into the iQIES database. The customer service representatives in the Provider Contact Center (PCC) does not have access to this information. If the OASIS was successfully accepted and verified in iQIES and the required data elements match the claim, but you continue to encounter issues, please contact the PCC at 1.877.299.4500 (option 1) for further assistance.

If there is no error and it is determined the services did not meet the condition of payment, submit a claim for denial using the following coding elements:

Type of bill 0320, which indicates the expectation of a full denial
Occurrence Span Code 77 with span dates matching the From/Through dates of the claim to indicate acknowledgement of liability for the billing period.
Condition Code D2 indicating the change in billing the HIPPS code to non-covered.
Condition Code 20.
DO NOT use condition code 21.

For additional information, refer to the following resources.