31324

FISS Narrative:
The claim contains a line(s) with provider submitted non covered charges and a GL, GY or TS HCPCS modifier is present on an outpatient claim. When this code is present on an 81X or 82X TOB for revenue code 0659 with HCPCS code 9270; it denotes a hospice room and board denial.

Explanation and Suggestion:
This is a valid processing reason code. It does not reflect incorrect billing. The provider has submitted non-covered charges with HCPCS modifier GL, GY or TS on an outpatient claim. The service line with HCPCS modifier GL, GY or TS is reported as non-covered to appropriately assign liability to the beneficiary for payment.

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