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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 U538I

Description:

A home health RAP or claim overlaps an existing episode with a different provider number. This error most commonly occurs when a beneficiary elects to transfer from one HHA to another during a 60 day episode or 30-day period of care under the home health Patient Driven Groupings Model (PDGM) and the receiving HHA submits their initial episode RAP/claim without a condition code 47 to indicate a transfer between HHAs.

Resolution:

Additional Resources


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