Adjustment Reason Codes - JE Part A
Adjustment Reason Codes
Adjustment reason codes are required on Direct Data Entry (DDE) adjustments on type of bill (TOB) XX7 and are entered on DDE claim page 3. Adjustment Reason Codes are not used on paper or electronic claims.
| Code | Description |
|---|---|
| AA | Automated Adjustment |
| AD | Admission Denial - Technical Denial (Peer Review Organization (PRO) Review Code - A) |
| AM | Admission Denial - No Payment (Medical Denial) (PRO Review Code - A) |
| AR | Admission Reversal - Hard Copy Adjustment |
| AU | Automobile |
| AW | Admission Denial - Payable Per Waiver |
| BL | Black Lung |
| CA | Cost Outlier Approved |
| CB | Credit Balance Accounts |
| CD | Covered Days Changes (PRO Review Code - B) |
| CO | Cost Outlier - No Payment (PRO Review Code - E) |
| CP | Cost Outlier Partial Approved |
| CR | Claim Reconsideration |
| CW | Cost Outlier Denial - Payable Per Waiver |
| DA | Day Outlier Approved |
| DB | Disability |
| DC | Diagnosis Changes (PRO Review Code - C) |
| DD | Discharge Destination Code Changes (PRO Review Code - C) |
| DG | Diagnosis Related Grouper (DRG) Change and Day Outlier Denial (PRO Review Code - G) |
| DH | DRG Change and Cost Outlier Denial (PRO Review Code - H) |
| DI | DRG and Beneficiary Liability Change (PRO Review Code - I) |
| DO | Day Outlier Denial - No Payment (PRO Review Code - D) |
| DP | Diagnosis and Procedure Changes (PRO Review Code - C) |
| DS | Discharge Status Change |
| DV | DRG Validation (PRO Review Code - C) |
| DW | Day Outlier Denial-Payable Per Waiver |
| EF | End Stage Renal Disease (ESRD) Adjustment Fix to Correct Original Claims |
| ES | ESRD |
| FB | Beneficiary Liability Change (PRO Review Code - F) |
| FC | Home Health Prospective Payment System (HHPPS) Final claim |
| FD | Full Denial (PRO Review Code - A) |
| FR | Full Reversal (PRO Review Code - N) |
| FT | Full Denial - Technical Denial (PRO Review Code - A) |
| HA | Home Health 485/486 Postpayment Audits |
| HC | Home Health Covered Compliance Reviews |
| HD | Health Maintenance Organization (HMO) Disenrollment |
| HP | HMO Pay |
| IB | Prospective Payment System (PPS) Interim Bill |
| IC | Non-Billable Revenue Codes Invalid Revenue Codes |
| ID | Inpatient or Blood Deductible |
| JP | Deemed Admission Change in Days (PRO Review Code - J) |
| KB | Deemed Admission Change in Days (PRO Review Code - J) |
| KD | Deemed Admission/Diagnosis Code Change (PRO Review Code - K) |
| KP | Deemed Admission/Procedure Code Change (PRO Review Code - K) |
| LD | Deemed Admission/Day Outlier Denial (PRO Review Code - L) |
| LI | Liability |
| LS | Length of Stay Denial-No Payment |
| LW | Length of Stay Denial-Payable Per Waiver |
| MC | Deemed Admission/Cost Outlier Denial (PRO Review Code - M) |
| MR | Medical Review |
| NF | HHPPS No Final Claim |
| OC | Procedure Codes Changed, Denied, or Added (PRO Review Code - R) |
| OP | Day Outlier Approved |
| OT | Other Change |
| PC | Procedure Changes (PRO Review Code - C) |
| PD | Procedural Denial - No Payment |
| PH | Public Health Service (PHS) MSP Value Code 16 |
| PI | Program Integrity |
| PN | Provider Number Change |
| PP | Discharge Status Change (PRO Review Code - P) |
| PR | Previous Adjustment Modified (Modifies the PROs Last Action) (PRO Review Code - O) |
| PT | Admission Denial and DRG Change (PRO Review Code - T) |
| PW | Procedural Denial - Payable Per Waiver |
| QC | Procedure Codes (HCPCS) Changed/Deleted/Added (PRO Review Code - R) |
| QD | Ancillary Services Denied or Approved (PRO Review Code - Q) |
| QR | HCPC Added/Deleted/Changed with Ancillary Change (PRO Review Code-S) |
| R1 | Reopening Performed within 1 Year of the Date of the Initial Determination |
| R2 | Reopening Performed Greater than 1 Year and up to 4 years from the Date of the Initial Determination |
| R3 | Reopening Performed Greater than 4 Years of the Date of the Initial Determination |
| RI | Recovery Audit Contractor (RAC) Identified Overpayment |
| RC | Complete Reversal of Previous Adjustment (PRO Review Code - N) |
| RP | Partial Reversal of Previous Adjustment (PRO Review Code - O) |
| SB | Same Benefit Period |
| SD | Seven Day Readmission Denial |
| SW | Seven Day Re-admission Denial - Payable Per Waiver |
| SQ | Qualified Independent Contractor |
| TD | Transfer Denial - No Payment |
| TW | Transfer Denial - Payable Per Waiver |
| VA | Veteran's Administration |
| WC | Worker's Compensation |
| WE | Working Elderly |
| YA | Pacemaker Denial - No Data |
| YB | Pacemaker Denial - With Errors |
| YC | Pacemaker Reversal to Denial |
| YD | Pacemaker Reversal to Denial and not going to pay |
| ZW | Debit Adjustment being processed for Provider and Intermediary and an initial bill is being processed to Common Working File (CWF) |
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