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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 30949

Description:

The adjustment (type of bill XX7, or XX8) or reopening request (type of bill XXQ) does not include a claim change reason code.

Resolution:

When submitting an adjustment (XX7) or a cancel (XX8), a Claim Change Reason Code is required. Choose only one of the following codes that best describes the adjustment request.

D0 - change dates of service
D1 - change charges
D2 - change revenue/HCPCS code
D7 - Change to make Medicare secondary
D8 - Change to make Medicare primary
D9* - Other/multiple changes
E0 - change patient status

When D9 is used, an explanation of the adjustment must be included in the Remarks field (FL 80 or FISS Claim Page 04). The adjustment request will be suspended for review.

Refer to the Adjustments/Cancels web page for additional information.

When submitting a Reopening request for one of the following reasons, for claim corrections, untimely filing rejections or ordering/referring denials, one of the above codes must be submitted as instructed on the Reopenings web page.

Posted: 09.14.20

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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