Reason Code 37544 - JF Part A

Reason Code Narrative

UB92 PROVIDER SUBMITTED ADJUSTMENT (XX7) INDICATES ADJUSTMENT IS DUE TO CHANGES IN CHARGES. CONDITION CODE D1 IS PRESENT AND ALL CHARGES ON THE ADJUSTMENT BILL EQUAL THE CHARGES ON THE ORIGINAL. IF CONDITION CODE D1 IS PRESENT, COVERED CHARGES MUST DIFFER.

Common Reason Code Errors

• Condition code D1 is billed; however, there are no changes made to covered charges.

Common Reason Code Corrections

• Direct Data Entry (DDE) users must delete non-covered line items and rekey charges into covered.
• Change condition code to most appropriate "D" code and include remarks if needed.

Resource

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

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