Reason Code W7088 - JE Part A

Reason Code Narrative

FQHC PPS TOB 77X IS SUBMITTED AND AT LEAST ONE OF THE SPECIFIC PAYMENT CODES G0466, G0467, G0468, G0469 OR G0470 IS NOT PRESENT.

THIS MAY BE BYPASSED FOR FQHC PPS CLAIMS WHEN TELEHEALTH ORIGINATING SITE SERVICES HCPCS CODE Q3014 IS REPORTED AND THE IS NO FQHC PAYMENT CODE OR QUALIFYING VISIT CODE PRESENT.

EFFECTIVE 01/01/2016, REASON CODE WILL BE BYPASSED FOR FQHC PP CLAIMS WHEN CCM HCPCS CODE 99490 IS PRESENT WITHOUT A FQHC PAYMENT CODE OR QUALIFYING VISIT CODE.

Common Reason Code Errors

• Claim submitted without G0466, G0467, G0468, G0469, or G0470 present.

Common Reason Code Corrections

• Verify and update/include as needed one of the specific payment codes G0466, G0467, G0468, G0469, or G0470.

Resources

• CMS Change Request (CR) 8743
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 50 and 60.2

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