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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.

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Reason Code 31605

Description:

The dates of services on the claim cannot be within the span code 77 dates unless the charges are non-covered.

Resolution:

The occurrence span code 77 is used to indicate the span of days that were not covered on claims when one of the following situations occurred:

  • The recertification was not obtained timely (by the end of the 3rd calendar day after the start of each benefit period). Enter the FROM and TO dates of the period of care for which the provider is liable. Note that condition code 85 (Delayed recertification of hospice terminal illness) must be reported for claims received on or after January 1, 2017. Refer to MM9590External PDF for additional information.
  • The NOE was not submitted timely (within 5 calendar days after the hospice admission date). Enter the FROM and TO dates of the period of care for which the provider is liable.

NOTE: This code should not be used to indicate and untimely Face-To-Face encounter.

Refer the Occurrence Span Codes and Dates information found on the Claim Page 01 - Entering a Hospice Claim Web page.


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