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Last Modified: 10/21/2022 Location: FL, PR, USVI Business: Part A

Avoiding RTP reason code 31255 to 31257 FAQ

Q: My claim was returned to provider (RTP) for reason code 31255, 31256 or 31257. How can I prevent claims from being returned for this reason code?
Refer to Part A lookup for descriptions associated with Medicare Part A reason codes. Enter a valid reason code into the box and click the submit button.
A: Prior to submitting your claim, verify that the appropriate therapy revenue code (042X, 043X and/or 044X) is submitted, along with the related occurrence code (17, 29 and/or 30), and the date the therapy plan was established or last reviewed.
Claims submitted on or after July 3, 2006, for outpatient or inpatient therapy services (type of bill 12X, 13X, 22X, 23X, 34X, 74X or 75X) not covered in the Part A stay will RTP for reason code:
31255 - physical therapy (revenue code 042X) was billed without occurrence code 29, or claim was submitted with occurrence code 29 but without revenue code 042X
31256 - occupational therapy (revenue code 043X) was billed without occurrence code 17, or claim was submitted with occurrence code 17 but without revenue code 043X
31257 - speech language pathology (revenue code 044X) was billed without occurrence code 30, or claim was submitted with occurrence code 30 but without revenue code 044X
Refer to the Rehabilitation Services specialty page designed specifically for rehabilitation service providers.
Sources: CMS IOM Pub.100-04 Medicare Claims Processing Manual, Chapter 5, section 30, and Chapter 25, section 75. external pdf file
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