Reason Code 12302

Published 12/16/2019

Covered days: the sum of the utilization days calculated plus the number of the non-utilization days calculated must equal the number of days between the from and through dates in the statements covers period unless:

  1. Patient status = 30 (add one day to the calculation)
  2. Transfer — the from and through date are the same, patient status 02, 03, 05, 50, 51, 61, 62, 63, 65, 66, 71, 72, 82, 83, 85, 89, 90, 91, 93, 94 with a condition code 40. The claim must show zero utilization days and one non-utilization day.
  3. The from and through days are the same but no condition code 40 is present. The claim must have one utilization day. Or 11x TOB with dates of service 7/1/06 and greater for provider ranges xx-0001 thru xx-0999, xx-1300 thru xx-1399, and xx-3300 thru xx-3399 and the sum of the covered (including coinsurance and lifetime reserve days) and non-covered days are equal to one.

This reason code is an indication that the total number of days represented by the "From" and "Through" dates has not been calculated correctly. This reason code may frequently be received in conjunction with reason code 12206. Be certain to take note of the factors indicated in the reason code narrative to assure that the days are being calculated as expected by FISS and the Medicare program.

CMS Internet Only Manual (IOM), Publication 100-4, Medicare Claims Processing Manual.

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