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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 C7010


Records show that the beneficiary has elected the Medicare hospice benefit and services billed as being related to the terminal diagnosis.


  • Verify with the beneficiary or their representative what health care services they are currently receiving at the time you admit them for Medicare home health care.
  • Review the beneficiary's Medicare eligibility information posted to Common Working File (CWF) at the time of admission and prior to submitting home health Requests for Anticipated Payment (RAPs) and final claims to Medicare to determine whether the beneficiary has elected the hospice benefit and whether this election impacts your dates of service.
    • See the CGS Checking Beneficiary Eligibility Web page for more information about the systems available to providers to check Medicare beneficiary eligibility information.
  • If services are unrelated to the terminal diagnosis, ensure condition code "07" is entered in FL 18-28 of the CMS-1450 claim form. Enter this in the first available COND CODES field on FISS Page 01.


  • Condition code "07" can only be used when the services are unrelated to the terminal diagnosis; any other use of condition code "07" may be considered abusive.

For additional information regarding the impact of a hospice election for beneficiaries receiving home health services, please see the CGS Election of the Medicare Hospice Benefit While Receiving Home Health Services During an MA Plan Enrollment Period Web page.

Updated: 10.24.18

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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