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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 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

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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