Reason Code 31428

Published 09/25/2020

New
Reason Code 31428

Description
The claim contains a hospice discipline revenue code (42X, 43X, 44X, 55X, 56X or 57X) and is either missing or has an incorrect corresponding HCPCS code (G0151, G0152, G0153, G0154, G0155 or G0156).

Resolution
Ensure that your claim contains the appropriate HCPCS code on the discipline revenue code line.

Revenue Code (Discipline)
HCPCS Codes
042X (Physical therapy)
G0151
043X (Occupational therapy)
G0152
044X (Speech-language pathology)
G0153
055X (Skilled nursing)
G0299 (valid for services on or after January 1, 2016)
G0300 (valid for services on or after January 1, 2016)
G0154 (not valid for services on or after January 1, 2016)
056X (Medical social services)
G0155
057X (Aide)
G0156
  • Ensure that the HCPCS code is keyed using a "0" (number zero); not an "O" (letter O).
  • Ensure that the HCPCS code begins with the letter "G," not the letter "Q."

Additional resource: Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, §30.3 (PDF).

 

 


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