This reason code is assigned when the type of bill (TOB) equals xx7 or xx8, but the claim change reason ‘condition code’ is not present on the bill.

Condition codes: 

• D0 - Changes to service dates
• D1 - Changes in charges
• D2 - Changes in revenue code / HCPC
• D3 - Second or subsequent interim PPS bill
• D4 - Change in grouper input (DRG)
• D5 - Cancel only to correct a Medicare ID or provider number
• D6 - Cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment
• D7 - Change to make Medicare secondary payer
• D8 - Change to make Medicare primary payer
• D9 - Any other changes
• E0 - Change in patient status 

Please add the appropriate condition code listed above in the reason code narrative to correct your claim and resubmit.

The Part A Reason Code Lookup Tool can provide a description associated with the Medicare Part A reason code(s). Enter a valid reason code into the box and click the submit button.

For additional information, view our Claims: Adjusting, reopening, and resubmitting article.

Reference

• Medicare Part A direct data entry (DDE) manual