Reason Code 37538 - JF Part A

Reason Code Narrative

UB92 PROVIDER SUBMITTED ADJUSTMENT (XX7) IS MAKING A LINE ITEM COVERED THAT WAS NONCOVERED ON ORIGINAL CLAIM. SAME REVENUE CODE ON BOTH CLAIMS WITH COVERED CHARGES ON ADJUSTMENT, BUT NON COVERED CHARGES ON ORIGINAL.

Common Reason Code Errors

• A non-covered line on original claim is being moved to covered on an adjustment and claim change condition code D1 is not being billed.
• A claim change condition code is billed but a more appropriate "D" condition code is available.

Common Reason Code Corrections

• Changes made to covered charges need to be billed with a D1 claim change condition code.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 130.1.2

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