Reason Code 12205
Reason Code Narrative
STATEMENT COVERS PERIOD: OUTPATIENT BILL TYPES 12-14X, 22-24X, 13X, 43X, 71-72X, 74X, 75X, 83X, AND 85X MUST INSURE THAT THE FROM AND THRU DATES USED TO REFLECT THE DATES OF THE FIRST AND LAST SERVICE ARE IN THE SAME CALENDAR YEAR.
Common Reason Code Errors
- An outpatient claim was submitted with a ‘from' and ‘through' date that overlaps calendar year end
Note: Medicare outpatient deductible and coinsurance amounts are based off of calendar year
Common Reason Code Corrections
- When "From" and "Through" years are different, submit a separate claim for each year. (Also known as split-billing)
Note: When split billing a claim, be sure claim for first calendar year processes and finalizes before submitting claim for second calendar year
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 70.8.1
View reason code list, return to Reason Code Guidance page.
Last Updated Aug 20, 2018