Reason Code 34978

Description

This Reason Code Will Assign When:

• The Type of Bill (TOB) is equal to 13X or 14X
• The Provider PTAN/Oscar ranges are equal to XX0001–XX0999, XX1200–XX1299, XX3025–XX3099, XX3300–XX3399, XX4000–XX4499
• One, or more line items on the claim do not contain a PO, PN or ER HCPCS modifier
  • For DDE claims: The address is present on MAP171F, Claim Page 03, and matches the address on the Provider Practice Query Screen, MAP1AB2. The Dates of Service (including the statement "from" date), are within the effective/termination date range listed on the Provider Practice Address Query Summary (PDF), Option 1D , MAP1AB1
    • 1D screen displays the address as found in PECOS

Resolution
The provider number billed is deemed a provider-based location and should submit with the appropriate PO/PN/ER modifier.

• Ensure line item contains the appropriate PO/PN/ER modifier
  • Report the PO HCPCS modifier for any services provided at an excepted off-campus provider-based department
  • Report the PN HCPCS modifier for any services provided at a non-excepted off-campus provider-based department
  • Report the ER HCPCS modifier for any services provided at an off-campus provider-based emergency department
• If the address is an off-campus provider-based location, has not been entered on the 855A, and the facility has not been deemed grandfathered, the address must be added to 855A via PECOS
• If the provider-based status has changed, and the facility is no longer wholly owned and operated by a main facility, notify Palmetto GBA of this change in relationship

References

• 42 Code of Federal Regulations (CFR) 413.65 (PDF)  
• Medicare Learning Network (MLN) Matters (MM) 9613 (PDF)  
• MM 9907 (PDF)   
• Section 1833(t)(21)(B)(iv)(II) of the Social Security Act 
• Special Edition (SE) 18023 (PDF)
• CMS MLN Matters article SE19007 (PDF)