Reason Code 38038 - JF Part A

Reason Code Narrative

On Outpatient OPPS Types of Bills (12X, 13X, 14X, 34X, 75X, 76X, or any bill containing Code 07), the following condition exists:

• A history claim is present that contains overlapping dates, with the Provider Numbers equal, and at least one-line item Date of Service is equal (for OPPS services) without
• Condition Code 'G0' '20' or '21' present on the claim. For this condition an adjustment bill must be submitted.

Common Reason Code Errors

• Claim submitted is duplicate of previously submitted claim and one of above-mentioned conditions exists.

Common Reason Code Corrections

• Verify if claims should be billed separately or combined.
  • Examples of separately billable services are ambulance, repetitive, preventive.
• Verify duplicate services have appropriate modifiers, if applicable.
• If additional charges must be included on prior claim submit, an adjustment.
• Do not submit a new claim.

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 9

View reason code list, return to Reason Code Guidance page.