Reason Code 12811

Occurrence code must be blank or a two-character code of: > 01-99 or A0-Z9 or AA-ZZ with a valid date.


  • For occurrence code 21, the associated date cannot be after the claim "Through" date
  • For occurrence code 22, the associated date must be within the “From” and "Through" date of the claim, unless the claim has a non-payment code of C, N or W then the date can be prior to the “From” date
  • For occurrence codes 26, 32 or 42 the associated date must be within the “From” and "Through" date of the claim

Note: the fourth digit of the reason code indicates the position in which the error occurred. The sequence is 1-0 (0 denotes the tenth occurrence) and A-T (T denotes the thirtieth occurrence).

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

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