Reason Code 37257

Published 10/02/2020

This reason code is assigned because the Value Code 85 and the Federal Information Processing Standards (FIPS) state and county code, is missing or invalid. The FIPS code is required on home health requests for anticipated payment (RAPs) and claims effective for dates of service on or after January 1, 2019.

For RAPs and claims with dates of service on or after January 1, 2019, ensure that Value Code 85 is present and the FIPS code. Value Code 85 is defined as “County Where Service is Rendered.”
The FIPS state and county code can be found at the following websites:

When entering a value code that represents a number rather than a monetary amount, enter the number followed by two zeros. For example, FIPS code 19153 would be entered as 1915300 or 19153.00.

If the FIPS state and county code begins with a zero, do not enter the zero. Enter the four digits that follow the zero. For example, 08019 would be entered as 801900 or 8019.00.

Reference: MLN Matters® Article MM10782 (PDF) - Home Health Rural Add-on Payments Based on County of Residence.

Was this article helpful?