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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 37238

Description:

The HCPCS G-code submitted is not reported with the correct corresponding revenue code.

Resolution:

Reason code 37238 will display when a G-code HCPCS is submitted with an incorrect revenue code. Before submitting your claim, ensure that the G-codes listed below are reported with the corresponding revenue code.

HCPCS

Services performed in 15-minute increments

REV Code

G0151

Physical Therapy

042X

G0152

Occupational Therapy

043X

G0153

Speech-Language Pathology

044X

G0154
(see note)

Direct skilled services of a licensed nurse (LPN or RN) NOTE: Not valid for visits made on or after 1/1/2016

055X

G0155

Clinical Social Worker

056X

G0156

Home Health Aide

057X

G0157

PT assistant

042X

G0158

OT assistant

043X

G0159

PT establish or deliver safe and effective PT maintenance program

042X

G0160

OT establish or deliver safe and effective OT maintenance program

043X

G0161

SLP establish or deliver safe and effective SLP maintenance program

044X

G0162

RN (only) for management and evaluation of POC NOTE: Not valid for visits made on or after 1/1/2017

055X

G0163
(see note)

LPN or RN for the observation and assessment of the patient's condition
NOTE: Not valid for visits made on or after 1/1/2017

G0164
(see note)

LPN or RN training and/or education of patient or family member
NOTE: Not valid for visits made on or after 1/1/2017

G0299
(see note)

Direct skilled services of a licensed nurse (RN)
NOTE: Valid for visits made on or after 1/1/2016

055X

G0300
(see note)

Direct skilled services of a licensed nurse (LPN)
NOTE: Valid for visits made on or after 1/1/2016

055X

G0493
(see note)

RN for the observation and assessment of the patient's condition
NOTE: Valid for visits made on or after 1/1/2017

055X

G0494
(see note)

LPN for the observation and assessment of the patient's condition
NOTE: Valid for visits made on or after 1/1/2017

055X

G0495
(see note)

RN training and/or education of a patient or family member
NOTE: Valid for visits made on or after 1/1/2017

055X

G0496(see note)

LPN training and/or education of a patient or family member
NOTE: Valid for visits made on or after 1/1/2017

055X

Resources:

  • CGS Claim Page 02 - Entering a RAP or Claim
  • MM9736External PDF, Implementation of Policy Changes for the CY 2017 Home Health Prospective Payment
  • MM9369External PDF, Additional G-Codes Differentiating RNs and LPNs in the Home Health and Hospice Settings
  • MM7182External PDF, New Home Health Claims Reporting Requirements for G Codes Related to Therapy and Skilled Nursing Services

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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