Skip to main content
Corporate

Reason Code Search and Resolution

Disclaimer: This is not a complete listing of reason codes.

This Reason Code Search and Resolution tool has been designed to aid Medicare providers in reviewing reason codes and how to resolve the edit or use them for determining if other action is needed. You may search this database by reason code or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of reason codes, their descriptions, resolutions, and additional billing information by clicking on the "Show all Reason Codes" option.

If no reason code displays, access the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) and select Option 17 “Reason Codes” from the Inquiry Menu to review the reason code description. For additional information refer to the Chapter 3: Inquiry MenuPDF of the FISS DDE Guide.

Search by:

Reason Code 31428

Description:

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, G0154, G0155, G0156).

Resolution:

  • 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:

Updated: 12.11.17


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved