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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 U523A


The dates of service on this claim are during both a Hospice election period and Medicare Advantage Plan Period that is Value-Based Insurance Design (VBID) Model.


This is for informational purposes only. No resolution is required by providers.

  • For Medicare beneficiaries who are MAO enrollees and have elected hospice on or after January 1, 2021 and prior to January 1, 2025, and the MAO plan is participating under the hospice benefit component of the VBID Model, all of his or her Medicare benefits will be covered by the MAO plan, not the MAC, such as CGS.
  • Hospice providers MUST still submit a Notice of Election (NOE) and claims to your MAC/CGS for services provided to a beneficiary enrolled in an MA plan participating in the VBID Model's hospice benefit component. Your MAC/CGS will deny payment for all claims with dates of service during a hospice election with start dates on or after January 1, 2021 through December 31, 2024. The following messaging will appear on your Medicare Remittance Advice.
    • Claim Adjustment Reason Code (CARC) 96: Non-covered charge(s)
    • Remittance Advice Remark Code (RARC) MA73: Information remittance associated with a Medicare demonstration. No payment issued under Fee-For-Service Medicare as patient has elected managed care
    • Group Code CO


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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