License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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J15 Part A Resolved Issues

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
06.11.2026	Closed	Part A and HHH	A Fiscal Intermediary Standard System (FISS) latency issue at the Kent Data Center is impacting myCGS portal and Direct Data Entry (DDE) users.	N/A	N/A	06.11.2026
MAC Action	We'll provide an update once the issue is resolved.
Provider Action	No provider action is required.
Proposed Resolution	The data center is working to resolve the issue, but there's currently no ETA. 06.11.2026: This issue is resolved.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
05.11.2026	Closed	Inpatient hospital	Reason Codes 32A00-32A74: Some transplant facility claims processed on or after April 6, 2026, returned to provider (RTP’d) in error.	32A00-32A74	N/A	05.21.2026
MAC Action	05.18.2026 – CGS updated the provider PECOS files to address the error on 05.18.2026. The system update to FISS was verified on 05.21.2026.
Provider Action	F9 or resubmit claims for processing.
Proposed Resolution	See MAC Action.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
04.17.2026	Closed	TOB 11X	Reason Code W2054: Inpatient claims that meet the length of stay (LOS) requirement for reporting mechanical ventilation returned to provider (RTP'd) in error.	W2054	ICD-10-PCS 5A195ZZ; LOS > 5 days	04.28.2026
MAC Action	CGS will suspend claims until the system is corrected. 04.29.2026 – CGS released the claims for processing.
Provider Action	No provider action. 04.29.2026 – If you identify claims that RTP'd in error, F9 or resubmit for processing.
Proposed Resolution	FISS will correct the LOS input to the Medicare Code Editor (MCE). 04.28.2026 – A system fix was installed.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Date Resolved
11.07.2025	Closed	Part A	Reason Code U5233: The Common Working File (CWF) Host identified an issue that caused a subset of HMO beneficiary claims to reject (no open HMO enrollment) in error.	U5233	12.02.2025
MAC Action	12.02.2025 – CGS initiated new claims on the provider's behalf. If you identify a claim that remains rejected in error, please F9 or resubmit for processing. Suspend claims until the issue is resolved.
Provider Action	N/A
Proposed Resolution	CGS will provide updates once the CWF Host notifies us that the issue is resolved.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
10.01.2025	Closed	RHC & FQHC	Reason Code C7252: Claims for Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) visits at a Skilled Nursing Facility (SNF) rejected in error.	C7252	TOB 71X or 77X Date of service on or after 07.01.2025 Receipt date on or after 08.01.2025	10.06.2025
MAC Action	CGS will identify and reprocess claims within 45 days.
Provider Action	No provider action.
Proposed Resolution	A system fix was installed on 10.06.2025.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
09.03.2025	Closed	RHC	Reason Code 39930: Rural Health Clinic (RHC) claims billed with Care Coordination Services received this edit in error	39930	TOB 71X with Care Coordination Services	10.06.2025
MAC Action	N/A
Provider Action	No provider action.
Proposed Resolution	10.06.2025 – A system fix was installed, and claims were released for processing. 09.03.2025 – Reason Code 39930 suspends claims when the claim level coinsurance due (Value Code A2) amount doesn't equal the sum of the line level coinsurance amounts. Claims will remain in suspense until a fix is installed. A fix is tentatively scheduled with the October 2025 release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.11.2025	Closed	TOB 85X	Reason Codes 31006 & 31007: Some Critical Access Hospital (CAH) Method II claims for professional services returned to provider (RTP'd) because the physician doesn't have a reassignment on file in PECOS.	31006, 31007	Dates of service on or after July 1, 2025; revenue codes 096X, 097X, or 098X	01.02.2026
MAC Action	Turn off reason codes 31006 & 31007 through December 31, 2025. Reprocess impacted claims to generate payment for the professional services.
Provider Action	An Office of Inspector General (OIG) audit (A-06-21-05003) identified that: Both CAHs and practitioners received payment for the same professional services. Practitioners billed for services after they reassigned their billing rights to a CAH. Change Request (CR) 13900 created edits to prevent such duplicate billing. Effective for dates of service on or after July 1, 2025, reason code 31006 or 31007 will assign on CAH Method II (TOB 85X) claims for professional services (revenue code 096X, 097X, or 098X) when: The Attending or Rendering Physician NPI doesn't have a reassignment on file in PECOS. Or, the line level date of service on the claim doesn't fall within the physician's reassignment effective and term dates in PECOS. Action: Ensure your professional providers submit their reassignment applications (CMS-855I) in PECOS for processing before January 1, 2026. See Part B Provider Enrollment for additional information.
Proposed Resolution	Temporarily turn off reason codes 31006 & 31007 to give providers additional time to submit their reassignment applications. Update: We reactivated reason codes 31006 & 31007 on January 2, 2026.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.29.2025	Closed	Outpatient TOBs except 12X & 22X	Reason Code W7113: Some claims returned to provider (RTP'd) in error	W7113	Supplementary or additional code not allowed as principal diagnosis code	10.06.2025
Updates
MAC Action	CGS will suspend claims to apply a workaround until the issue is resolved
Provider Action	If you identify RTP claims, please F9 or resubmit for CGS to apply the workaround.
Proposed Resolution	A system correction is planned for a future quarterly release. 10.06.2025 – An edit correction was implemented with the October 2025 quarterly release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
02.05.2025	Closed	RHC (TOB 71X)	Reason Code 39930: RHC claims for intensive outpatient program (IOP) services processed with an incorrect coinsurance amount.	39930	Condition code 92 Revenue code 0905 CPT/HCPCS code for IOP services Modifier CG	02.17.2025
Updates
MAC Action	02.18.2025 – CGS released suspended claims for processing. CGS will suspend impacted claims.
Provider Action	No provider action required.
Proposed Resolution	02.17.2025 – A system correction was installed. A system correction is scheduled on February 17, 2025.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
09.13.2024	Closed	Part A	Reason Code 342024: Claims billed with HCPCS code 75580 with cardiology revenue code 048X returned to provider (RTP'd) in error.	34204	HCPCS code 75580 with cardiology revenue code 048X	09.24.2024
Updates
MAC Action	CGS updated the appropriate system file to allow claims to process on 9.24.2024.
Provider Action	Resubmit or correct any claims that did not process as expected.
Proposed Resolution	CMS instructed MACs to update a system file to remove revenue code restrictions.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.15.2024	Closed	Part A	Reason Code U538H: An Eligibility Database (EDB) update that incorrectly identifies some beneficiaries as incarcerated caused the Common Working File (CWF) to reject claims in error.	U538H	N/A	10.23.2024
Updates
MAC Action	09.26.2024 – CGS will also adjust impacted claims not captured in the claim hold process within 30 business days. 09.23.2024 – CGS will release suspended claims for processing. NOTE: This includes any Informational Unsolicited Response (IUR) adjustments for claims that processed after the incarceration date. These claim rejections are valid. CGS will suspend claims to status/location (S/LOC) S MINCR until the issue is resolved.
Provider Action	No provider action.
Proposed Resolution	09.23.2024 – The CWF Host sites were updated with clean incarceration data from the EDB. CMS is researching to determine how to correct the incarceration date for impacted beneficiaries and process claims that rejected in error.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.29.2024	Closed	Outpatient facilities	Reason Code 32073: A system outage at the Virtual Data Center (VDC) caused claims for outpatient services to return to the provider (RTP) in error.	32073	Outpatient TOBs	07.30.2024
Updates
MAC Action	07.30.2024 – CGS reprocessed impacted claims. CGS will suspend claims until a resolution is determined.
Provider Action
Proposed Resolution	In research

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Date Resolved
07.09.2024	Closed	Part A	July 2024 remits are currently unavailable.	N/A	07.17.2024
Updates
MAC Action
Provider Action
Proposed Resolution	We are working quickly to restore them for you.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.03.2024	Closed	Part A	Reason Codes 326XX: One or more payer only codes may assign to a claim and cause it to return to provider (RTP) in error.	326XX	Payer only code(s)	04.07.2025
Updates
MAC Action	CGS removed value code Z9 from RTP claims submitted prior to, or during the installation of, the July 2024 release on 7.1.2024.
Provider Action	Remove any payer only codes before you F9/resubmit RTP claims or submit an adjustment or cancel claim. Refer to the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1, section 190 for a complete list of payer only codes.
Proposed Resolution	04.07.2025 – A system fix was installed. A system fix is scheduled for the April 2025 release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Claim Coding Impact	Date Resolved
04.23.2024	Closed	Outpatient claims	An incorrect status indicator assigned to outpatient claims with a line-item date of service on or after 1.1.2024 and CPT code 0621T or HCPCS code J7353.	LIDOS on or after 1.1.2024 and CPT code 0621T or HCPCS code J7353	07.01.2024
Updates
MAC Action	CGS will: Suspend claims to apply a workaround until the system update is implemented in July 2024 Adjust claims when brought to our attention
Provider Action	N/A
Proposed Resolution	CMS will correct errors to codes 0621T, J7353 and C9167 in the July 2024 Hospital Outpatient Prospective Payment System update. See the MLN Connects Newsletter: April 25, 2024, for details.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
02.21.2024	Closed	Outpatient claims	Reason Code W7092: Effective January 1, 2024, outpatient claims submitted with certain procedure codes returned to provider (RTP'd) for missing a device code in error.	W7092	HCPCS codes C1052, C1062, C1734, C1824, C1825, C1839, C1982 and C2596	04.01.2024
Updates
MAC Action	CGS will suspend claims to status/location (S/LOC) S M7092 to apply a workaround until the system update is implemented (scheduled in April 2024).
Provider Action	You may F9/resubmit any RTP claims you identify for CGS to apply the workaround.
Proposed Resolution	A system update is scheduled with the April 2024 release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Claim Coding Impact	Date Resolved
02.08.2024	Closed	Outpatient claims	Claims submitted with HCPCS codes G2066, 93297 or 93298 will return to provider (RTP) until a system correction is installed.	HCPCS codes G2066, 93297 or 93298	04.01.2024
Updates
MAC Action
Provider Action	We encourage you to hold claims for these services until the system correction is installed (scheduled in April). If you choose to submit claims prior to April, you may F9/resubmit any RTP claims you identify after the system correction is installed.
Proposed Resolution	Effective, January 1, 2024, claims for these services will RTP due to the following: HCPCS code G2066 terminated on 12.31.2023. CPT codes 93297 and 93298 assign to status indicator M (Items and services not billable to the MAC; not paid under OPPS). A system correction is scheduled for the April 2024 release. Once installed, CPT codes 93297 and 93298 will assign to a separately payable status indicator (Q1) and APC 5741, effective January 1, 2024.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
11.06.2023	Closed	Ambulance	Beginning on 10.02.2023, FISS did not retain the fractional units on Direct Data Entry (DDE) claims with ambulance mileage services.	32226	DDE claims with TOB 13X or 85X and ambulance mileage services	11.27.2023
Updates
MAC Action
Provider Action	You may F9/resubmit any claims that received reason code 32226 in error.
Proposed Resolution	11.27.2023 – A system correction was installed. A system correction is tentatively scheduled. We will provide updates when available.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.07.2023	Closed	Non-OPPS claims	Non-OPPS claims returned to provider (RTP'd) with reason code W7048 in error.	W7048	Claims received on or after July 1, 2023	01.02.2024
Updates
MAC Action	CGS will override reason code W7048 until the system update is implemented in January 2024.
Provider Action	You may F9/resubmit claims that RTP'd in error.
Proposed Resolution	01.02.2024 – A system correction was installed. A system update is scheduled with the January 2024 release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.02.2023	Closed	TOBs 22X, 23X and 85X	Certain outpatient rehabilitation claims returned to provider (RTP'd) with reason code W7072 in error.	W7072	Claims submitted between January 1 – June 30, 2023 Revenue codes 042X, 043X or 044X CPT codes 98980 and/or 98981	07.03.2023
Updates
MAC Action
Provider Action	You may F9/resubmit claims that RTP'd in error.
Proposed Resolution	A system update was implemented with the July 2023 quarterly release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.03.2023	Closed	Various Outpatient TOBs	Some claims for audiologists who furnished certain diagnostic tests without a physician order returned to provider (RTP'd) in error.	34963	Claims received on or after April 1, 2023, with modifier AB on all lines	01.02.2024
Updates
MAC Action	When all lines on the claim contain modifier AB, CGS will override reason code 34963 until the system update is implemented in January 2024.
Provider Action	Review claims that received reason code 34963. If modifier AB is reported on all claim lines, F9/resubmit the claim. If the claim also includes codes/lines without modifier AB, report the attending provider's name and NPI. If modifier AB is not reported on any claim lines, determine if it's appropriate to report modifier AB and/or the attending provider's name and NPI. NOTE: An audiologist is not a valid attending provider. Please reference the CMS MLN Matters articles MM12889 (reason code 34963) and MM13055 (modifier AB) for additional information.
Proposed Resolution	01.02.2024 – A system correction was installed. A system update is scheduled with the January 2024 quarterly release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
06.29.2023	Closed	ESRD	Due to a coding error, certain beneficiary records in the Common Working File (CWF) reflected an incorrect initial date of first dialysis (e.g., ESRD eligibility date or first of the month when the date of first dialysis occurred after the eligibility date). As a result, the onset payment adjustment for new ESRD beneficiaries did not apply to some ESRD claims correctly.	N/A	TOB 72X; Dates of service 05.01.22 – 06.13.23; Line item DOS for dialysis is within 120 days of the initial date of first dialysis	09.29.2023
Updates	09.22.2023 – Another refresh was completed to ensure all affected beneficiary records are correct. See the Provider Action and MAC Action sections below. 07.18.2023 – The refresh mentioned in the Proposed Resolution section below did not update all affected beneficiary records. CMS is still researching, and we will provide updates when they become available.
MAC Action	CGS will adjust affected ESRD claims within 120 days of a provider's request. See Provider Action below.
Provider Action	If you identify a claim that meets the criteria above, you may submit a claim adjustment (TOB 727) to correct the claim payment. Please indicate “ESRD Onset Adjustment Correction” in the Remarks field.
Proposed Resolution	The coding error was corrected on June 12, 2023, and a refresh of beneficiary records was completed in the CWF on June 13, 2023.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
06.15.2023	Closed	RHC	RHC claims paid under the all-inclusive rate (AIR) and billed with modifier CG may have processed with coinsurance in error.	N/A	TOB 71X Modifier CG Claims processed 5.15.2023 – 6.12.2023	07.31.2023
Updates
MAC Action	Claim adjustments occurred on 7.31.2023.
Provider Action	N/A
Proposed Resolution	The system logic was corrected on 6.12.2023.

Last Reviewed: 08.10.2026

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

J15 Part A Resolved Issues

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