Reason Code 31997

Published 09/14/2023

Description
The Type of Bill (TOB) is equal to inpatient (11x, 18x, 21x or 41x), the non-covered charges are greater than zero and are equal to the total charges, and Occurrence Span Code 79 or m1 is present on the claim. The reason for this edit is the entire claim is billed with non-covered charges with Occurrence Span Code 79 or M1.

Resolution
This is a valid processing reason code. It does not reflect incorrect billing.

Resource: CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 3 (PDF).


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