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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 32402

Description:

The home health or hospice claim includes at least one HCPCS code that is not valid, OR, at least one of the revenue code lines contains an invalid revenue code/HCPCS combination.

Resolution:

If you are billing a revenue code for skilled nursing, therapy or aide services, ensure the correct “G” HCPC code is reported. Refer to the listing below to ensure the correct revenue code and HCPC combination is reported.

Home Health Valid HCPCS Codes

HCPCS Code

Valid For Dates of Service

Description

G0299

Services provided on or after January 1, 2016

Direct skilled nursing services of a registered nurse (RN) in home health or hospice setting, each 15 minutes.

G0300

Services provided on or after January 1, 2016

Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes.

G0493

Services provided on or after January 1, 2017

Skilled services of a registered nurse (RN) for the observation and assessment of the patient's condition, each 15 minutes.

NOTE: Only valid for home health providers.

G0494

Services provided on or after January 1, 2017

Skilled services of a licensed practical nurse (LPN) for the observation and assessment of a patient's condition, each 15 minutes.

NOTE: Only valid for home health providers.

G0495

Services provided on or after January 1, 2017

Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

NOTE: Only valid for home health providers.

G0496

Services provided on or after January 1, 2017

Skilled services of a licensed practical nurse (LPN), in th training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

NOTE: Only valid for home health providers.

For home health episodes that span 2015/2016 or 2016/2017, report the appropriate G-code on the detail line based on the date of service.

Hospice Valid HCPCS Codes

HCPCS Code

Valid For Dates of Service

Description

G0299

Services provided on or after January 1, 2016

Direct skilled nursing services of a registered nurse (RN) in home health or hospice setting, each 15 minutes.

G0300

Services provided on or after January 1, 2016

Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes.

Home Health Invalid HCPCS Codes

HCPCS Code

Invalid For Dates of Service

Description

G0154

Services provided on or after January 1, 2016

Direct skilled services of a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes.

G0162

Services provided on or after January 1, 2017

Skilled services of a licensed nurse (RN only) for management and evaluation of the plan of care, each 15 minutes.

G0163

Services provided on or after January 1, 2017

Skilled services of a licensed nurse (LPN or RN) for the observation and assessment of the patient's condition, each 15 minutes.

G0164

Services provided on or after January 1, 2017

Skilled services of a licensed nurse (LPN or RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

Hospice Invalid HCPCS Codes

HCPCS Code

Invalid For Dates of Service

Description

G0154

Services provided on or after January 1, 2016

Direct skilled services of a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes.

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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