Reason Code W7089 - JE Part A

Reason Code Narrative

FQHC PPS TOB 77X AND ONE OF THE SPECIFIC PAYMENT CODE G0466, G0467, G0468, G0469, G0470 IS PRESENT AND A HCPCS CODE FOR THE QUALIFYING VISIT IS NOT REPORTED ON THE SAME DAY.

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

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

Common Reason Code Errors

• Claim submitted with G0466, G0467, G0468, G0469, or G0470 but no qualifying visit on the same day is present.

Common Reason Code Corrections

• Verify and update as needed to include a qualifying visit.

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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