Reason Code W7030 - JE Part A
Reason Code W7030
Reason Code Narrative
INSUFFICIENT SERVICES ON DAY OF PARTIAL HOSPITALIZATION.
Common Reason Code Errors
- Claim is lacking required number of services to qualify for Partial Hospitalization Program (PHP)
- PHP services were not performed on same date of service
Common Reason Code Corrections
- Check number of units billed on each line item
- Verify required numbers of services were provided to meet definition of PHP
- Verify all services were provided on same date of service
Resources
- CMS Definitions of Medicare Code Edits
- CMS Integrated Outpatient Code Editor (IOCE)
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260
- Appendix C of the OCE
View reason code list, return to Reason Code Guidance page.
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