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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 34952

Description:

A service facility National Provider Identifier (NPI) was required on the claim, but was not reported. Hospice providers are required to report a service facility NPI when billing any of the following place of service HCPCS codes.

  • Q5003 - hospice care provided in nursing long term care facility (LTC) or non-skilled nursing facility (NF)
  • Q5004 - hospice care provided in skilled nursing facility (SNF)
  • Q5005 - hospice care provided in inpatient hospital
  • Q5006 - hospice care provided in inpatient hospice facility (when not the same as the billing hospice)
  • Q5007 - hospice care provided in long term care hospital (LTCH)
  • Q5008 - hospice care provided in inpatient psychiatric facility

Resolution:

Before submitting your claim, check to see if any of the above HCPCS are present. If present:

  • The NPI of the nursing facility, hospital, or inpatient facility where the patient received services is required. Enter the service facility NPI in:
    • Loop 2310E (when billing in the 5010 electronic claim format); or
    • SERV FAC NPI field in the Fiscal Intermediary Standard System (FISS) on Claim Page 03.

32952

Resolution:

Before submitting your claim, check to see if any of the above HCPCS are present. If present:

  • The NPI of the nursing facility, hospital, or inpatient facility where the patient received services is required. Enter the service facility NPI in:
    • Loop 2310E (when billing in the 5010 electronic claim format); or
    • SERV FAC NPI field in the Fiscal Intermediary Standard System (FISS) on Claim Page 03.

32952


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