Reason Code W7030 - JF Part A

Reason Code Narrative

INSUFFICIENT SERVICES ON DAY OF PARTIAL HOSPITALIZATION.

Common Reason Code Errors

• Claim is lacking required number of services to qualify for Partial Hospitalization Program (PHP)
• PHP services were not performed on same date of service

Common Reason Code Corrections

• Check number of units billed on each line item
• Verify required numbers of services were provided to meet definition of PHP
• Verify all services were provided on same date of service

Resources

• CMS Definitions of Medicare Code Edits
• CMS Integrated Outpatient Code Editor (IOCE)
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260
• Appendix C of the OCE

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