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April 10, 2026

Reason Codes 31006 & 31007: Professional Reassignment to Method II CAH Not Found

Method II Critical Access Hospitals (CAHs) can only bill Medicare for both professional and facility services when physicians/practitioners reassign their Medicare billing rights to the hospital (i.e., submit a reassignment application online in PECOSExternal Website or mail the paper CMS-855IExternal PDF).

Background

An Office of Inspector General (OIG) audit (A-06-21-05003)External PDF identified that:

  • Both CAHs and physicians/practitioners received payment for the same professional services.
  • Physicians/practitioners continued to bill for services after they reassigned their billing rights to a CAH.

On July 7, 2025, Change Request (CR) 13900External PDF implemented edits (reason codes 31006 & 31007) to verify that a professional’s reassignment information is on file when a Method II CAH submits a claim (TOB 85X) for professional services (revenue codes 096X, 097X, or 098X).

Based on Return to Provider (RTP) claim volume, we temporarily deactivated the reason codes on:

  • August 13, 2025 – January 2, 2026
  • March 20, 2026, until further notice

These delays allow more time for Method II CAHs and physicians/practitioners to:

  • Verify reassignment information in PECOS.
  • Submit reassignment applications, if applicable.

Claim Edits

When the edits are reactivated, Method II CAH (TOB 85X) claims for professional services (revenue code 096X, 097X, or 098X) will RTP when:

  • Reason Code 31006:
    • A rendering provider NPI is present on a professional service line-item (LLR NPI) or at the claim level (REN PHYS NPI); and,
    • The rendering provider’s reassignment to the CAH is missing (LLR NPI/REN PHYS NPI isn’t present in PECOS or the Physician Reassignments to CAH (DDE inquiry 1G) screen); or,
    • The professional line-item date of service doesn’t fall within the rendering provider’s reassignment Effective and End Dates (in PECOS or the Physician Reassignments to CAH (DDE inquiry 1G) screen).
  • Reason Code 31007:
    • A rendering provider NPI isn’t present on a professional service line-item (LLR NPI) or at the claim level (REN PHYS NPI); and,
    • The attending provider’s reassignment to the CAH is missing (ATT PHYS NPI isn’t present in PECOS or the Physician Reassignments to CAH (DDE inquiry 1G) screen); or,
    • The professional line-item date of service doesn’t fall within the attending provider’s reassignment Effective and End Dates (in PECOS or the Physician Reassignments to CAH (DDE inquiry 1G) screen).

DDE Inquiry 1G (PHYS REASSIGN TO CAH)

Beginning on January 19, 2026, Direct Data Entry (DDE) Inquiry 1G (PHYS REASSIGN TO CAH) is available to help Method II CAHs avoid or correct RTP claims. Use this screen to verify the following:

  • If a rendering NPI is reported on the claim (line-item or claim level), the rendering provider’s reassignment to the Method II CAH is on file.
  • If a rendering NPI isn’t reported on the claim (line-item or claim level), the attending provider’s reassignment to the Method II CAH is on file.
  • All physician/practitioner reassignment information on file is correct.

To access this screen:

  • Type ‘01’ (Inquiries); press Enter.
  • Type ‘1G’ (Phys Reassign to CAH); press Enter.

Phys Reassignent to CAH

From the Physician Reassignments to CAH (MAP12M1) screen:

  • Search by Physician/Practitioner:
    • Type a valid physician NPI, CCN, or NPI/CCN combination.
    • Press Enter.
    • A list of all matching records will display.
  • Search by CAH:
    • Press the space bar in the Physician NPI or CCN field.
    • Press Enter.
    • A list of all CAH reassignment records the user is allowed to access will display.

Phys Reassignment to CAH - Search

  • To review record details, type ‘s’ in the SEL field, and press Enter.

Phys Reassignment to CAH - Details

Next Steps

Method II CAHs should review their enrollment records in PECOS or DDE to ensure:

  • A reassignment record exists for each eligible physician/practitioner.
  • The physician/practitioner reassigned benefits to the CAH’s Part A enrollment, not the clinic’s Part B enrollment.
  • The effective and end dates (i.e., the dates for which the physician/practitioner agreed to reassign benefits) are correct.

If information is missing or incorrect, the CAH or physician/practitioner must submit the CMS-855I enrollment application online in PECOS or mail a paper copy. Use the Provider Enrollment Interactive Help Tool for assistance.

References

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