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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 31147

Description:

A home health final claim was received, and the fifth position of the HIPPS code billed contains the letters S, T, U, V, W, or X, but supply revenue codes are not present on the claim.

Resolution:

  • If the HIPPS code on your claim has a 5th position of S, T, U, V, W, or X and you provided non-routine supplies to the beneficiary during the episode, report
    • Supply revenue codes 027X and/or 0623
    • Service units
    • Charges and
    • A date of service that falls within the "FROM" and "TO" date of the home health claim
      • CGS encourages you to use the first Medicare billable visit in the episode as the date of service submitted with revenue codes 027X or 0623.

    31147 Screen Shot

  • If non-routine supplies were NOT provided by your home health agency to the beneficiary during the episode, the 5th position of the HIPPS code must be changed to the appropriate numeric value of 1, 2, 3, 4, 5, or 6. For example, if the HIPPS code for the episode was 2BFKV, it will need to be changed to 2BFK4 if non-routine supplies were not provided to the beneficiary. Make sure that when changing the 5th position of the HIPPS code from a letter to a number or vice versa, you do not change the supply severity level assigned to the HIPPS code for the episode. See the table below for the supply severity levels and corresponding values to report whether non-routine supplies were provided during the episode.
  • Please note that the fifth position of the HIPPS code does not need to match between the final claim and the request for anticipated payment (RAP). Therefore, if the RAP is reported with the fifth position of the HIPPS code of 1, 2, 3, 4, 5, or 6 and non-routine supplies were provided, the RAP does not need to be canceled prior to submitting the final claim.
    • However, you must ensure that the HIPPS code on the final claim is submitted with the corresponding letter for the supply severity level, and that the supply revenue codes, units, charges, and dates of service are present prior to submitting the claim.

Additional Resources

Updated: 12.26.12

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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