Reason Code 34985 - JE Part A
Reason Code 34985
Reason Code Narrative
THE TOB IS EQUAL TO 13X OR 14X, THE CLAIM FROM DATE OF SERVICE IS ON OR AFTER 04/01/2020, PO MODIFIER IS NOT PRESENT ON THE CLAIM, A PRACTICE LOCATION IS PRESENT ON THE CLAIM AND MATCHES TO AN ENTRY ON THE PROVIDER PRACTICE ADDRESS FILE (MAP1AB2), THE 603 PBD EXCEPTION VALUE IS EQUAL TO 4, OR THE 603 GRANDFATHERED PBD EXCEPTION VALUE IS EQUAL TO 'BLANK' OR 4 ON THE PROVIDER PRACTICE ADDRESS FILE (MAP1AB2).
Common Reason Code Errors
- PO modifier is missing from one or more claim lines and practice location present on the claim and matches entry on Provider Practice Address Query Screen (MAP1AB2) in DDE or PECOS.
- PO modifier is used for services, procedures and/or surgeries provided in excepted off-campus outpatient PBD.
- Applies to grandfather and/or excepted PBD and paid under OPPS.
- Grandfathered means facility became PD before November 2, 2015.
Common Reason Code Corrections
- Verify billing and, if appropriate correct by adding PO modifier to applicable claim line(s).
- Verify that the NPI number is correctly entered.
- Ensure that each PTAN associated with the NPI has its own unique zip code plus four.
- Verify and confirm practice location matches entry on Provider Practice Address Query Screen (MAP1AB2).
- To access the Provider Practice Address Query option from the FISS online inquiries submenu, type '1D' at the Enter Menu Selection: prompt, then press the <Enter>key. The Provider Practice Address Query Summary screen (MAP1ABI) will be displayed.
- To access practice address information, enter the NPI and/or OSCAR, and press the <Enter> key. A list of provider practice locations will be displayed.
- Correct the information and resubmit the claim.
Resources
Last Updated Jul 08 , 2025