Reason Code 32243 - JF Part A

Reason Code Narrative

TOTAL CHARGES ON THE LINE ITEM BEING EDITED MUST BE GREATER THAN ZERO UNLESS THE FOLLOWING IS TRUE: REVENUE CODE 180 - 189; TOB = 13X, 83X OR 85X; PATIENT STATUS = 02 OR 03 OR 61; OVERRIDE CODE = 4; AND TOB = 12X, 14X OR 74X; PATIENT STATUS = 02 OR 03 OR 61; OVERRIDE CODE = 4; AND TOB = 12X, 14X OR 74X; CONDITION CODE 40 IS PRESENT ON THE CLAIM. PPS EFFECTIVE DATE EQUALS THE FROM AND THRU DATES ON THE CLAIM AND IT IS A PPS TRANSITION CLAIM.

NOTE: EFFECTIVE 4/1/2010 FQHCS, FREE STANDING (XX1000-XX1199) AND PROVIDER BASED FACILITIES (XX1800-XX1989), MUST BE SUBMITTED ON TOB 77X.

Common Reason Code Errors

• This claim level reason code is being returned to the provider because one or more for line items were submitted without associated charges.

Common Reason Code Corrections

• Report a token charge of less than $1.01 (commonly $0.01) in the non-covered charge field.
• Include the corresponding CPT or HCPCS code and ICD-10 code that represents the service.
• Add the appropriate ICD-10 diagnosis that supports the quality measure being reported.

Resources

• CMS Medicare Learning Network (MLN) Matters: MM10521 - Institutional Billing for No Cost Items
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual Chapter 32 - Billing Requirements for Special Services, Section 67.2