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Reason Code Search and Resolution

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

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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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

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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