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Printed Date: 9/22/2015
Revenue codes 821, 880, 881, 831, 841 or 851 are present on an End State Renal Disease (ESRD) claim with condition code 74 for a beneficiary who has not selected Method I.
Note: Online users, make corrections and F9 to update the claim.
Explanation and Suggestions:
This reason code indicates that there is a discrepancy between the services being billed and the ESRD Method of Dialysis code stored on the Common Working File (CWF). Ensure that the dialysis revenue code on the claim is correct for the type of dialysis received by the patient.
Note: Per Change Request (CR) 7064, for claims with dates of service on or after January 1, 2011, payment for home dialysis items and services furnished under Method II is included in the ESRD PPS payment rate, regardless of home treatment modality. Therefore, all home dialysis claims:
CR 7064 instructs DME MACs to stop separate payment to suppliers for Method II home dialysis items and services. All 72x claims from Method II facilities with condition code 74 will be treated as Method I claims as of January 1, 2011. Effective that same date, Medicare will no longer enter Method Selection Forms data into its system.
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Last Updated: 12/27/2018