Reason Code 31836 - JE Part A

Reason Code Narrative

THE HCPC ON THE REVENUE CODE LINE HAS A STATUS CODE OF 'M', BUT THE TOB IS NOT EQUAL TO 85X OR THE TOB IS 85X, BUT THE REVENUE CODE IS NOT EQUAL TO 96X, 97X OR 98X WITH DATES OF SERVICE ON OR AFTER 1/1/15.

Common Reason Code Errors

• The claim was returned because the HCPCS code associated with the revenue code line has a status indicator "M."
• The Medicare Physician Fee Schedule (MPFS) status indicator "M" describe services for physicians or professionals only.
• Outpatient Prospective Payment System (OPPS) status indicator "M" indicates items and services are not billable to the MAC and therefore not paid under OPPS.

Common Reason Code Corrections

• Verify billing and if appropriate, correct and resubmit the claim for payment.

Resources

• CMS -1809-FC: Hospital Outpatient Prospective Payment - Notice of Final Rulemaking (NFRM) - NFRM OPPS Addenda