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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 U5387

Description:

The patient status code '30' (still patient) was submitted on the final claim and the through date do not equal the calculated episode end date on the file.

Resolution:

  • the dates of service reported on the claim should reflect a 30-day period of care. For example, if the admit date is 01/17/2020, the From and To dates of the first claim in the 30-daty period of care should be 01/17/2020 - 02/15/2020. Refer to the Home Health PDGM 30-day Period of Care Billing Calculator to determine the From date of service through the To or Through date of service.
  • If the patient has transferred to another home health agency during the period of care, ensure the To or Through date of service reflects the date of transfer/discharge.
  • Check the patient’s eligibility to ensure the From and To dates of the 30-day period are correct. Refer to the Checking Beneficiary Eligibility web page for options for checking eligibility

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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