Reason Code 12205

Published 12/16/2019

Outpatient bill types 12-14x, 22-24x, 34x, 71-72x, 74x, 75x, 83x and 85x must ensure that the from and thru dates used to reflect the dates of the first and last service are in the same calendar year.

This reason code is generated when the “From” and "Through" date on an outpatient claim overlap the calendar year end. Because Medicare outpatient deductible and coinsurance amounts are based upon the calendar year, it is not acceptable for the dates of service on an outpatient claim to overlap the calendar year end. You must split bill all outpatient services that overlap the calendar year. Please verify the dates of service billed on the claim. Correct the invalid date and submit a new claim.

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



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