Reason code 39910 causes claims to suspend when the provider reimbursement amount is equal to zero. Reason code 37187 is the finalized claim edit that indicates the claim has completed processing and no additional payment can be made.

These reason codes are most commonly received when the Medicare deductible amount matches the full payment amount on the claim. When no reimbursement is made to the provider due to the Medicare deductible, no Medicare payment will be issued to the provider.

These reason codes can also indicate that a billing error was made. When a claim is submitted with certain invalid or missing information, it can result in the claim receiving a zero dollar reimbursement amount. We encourage providers to confirm that their billing is correct.

Some Common Billing Scenarios That May Result in a Zero Dollar Reimbursement:

All Providers / TOB (Type of Bills):

• Revenue code and the Healthcare Common Procedure Coding System (HCPCS) combination:
  • Ensure that the HCPCS billed is reported on the appropriate Revenue Code type
• For Direct Data Entry (DDE) users:
  • A shortcut (SC) is available that will assist providers with allowable HCPCS/Revenue combinations. Select SC 14 in DDE to view the HCPCS file and view allowable revenue code types. This SC is not all-inclusive, additional resources may be utilized to determine appropriate billing, such as the Internet Only Manuals, the Centers for Medicare & Medicaid Services website, etc.

Outpatient Claims (TOB 13x):

• Payable services are denied for a reason such as MUE (Medically Unlikely Edits) and only services that remain not denied are Status ‘N’ codes (packaged item or service:
  • Review line-item denials on claims
• For DDE users:
  • To determine the line item denial, go to Page 2 of your claim and press F2 to access the line levels. Press F6 to page through each line of the claim if necessary.
• Laboratory services:
  • Confirm that the HCPCS is submitted on a valid revenue code type, appropriate modifiers are submitted and any primary laboratory HCPCS are submitted that may be necessary
  • References related to laboratory billing that may be useful:
• Medicare Learning Network (MLN) Matters Article for Modifier L1 usage, MM8776 or SE1412
• CMS Claims Processing Manual, Pub.100-04, Chapter 16

Inpatient Claims (TOB 11x)

• Ensure the appropriate value codes are submitted to account for the days that are submitted on the claim, both covered and non-covered. Verify the beneficiary eligibility to determine number of days to bill
• Value code 80- covered days:
  • Note: This will include any full covered days, co-insurance days and Lifetime Reserve days as a grand total. Value Codes 82 and 83 will still be needed if that type of day is being utilized
• Value Code 81- Non-covered days
• Value Code 82- Co-insurance days
• Value Code 83- Lifetime reserve days

Rural Health Clinics (TOB 71x) and Federally Qualified Health Centers (TOB 77x)

Ensure there is a valid qualifying visit/encounter visit billed on the appropriate revenue code.

For more details on billing, please refer to MLN SE1039 for general and preventive service billing guidance or the CMS Claims Processing Manual, Pub. 100-04, Chapter 9 for Rural Health Clinics/Federally Qualified Health Centers:

• Additional RHC Information is available in the Rural Health Clinics Center
• Additional FQHC information is available in the Federally Qualified Health Centers (FQHC) Information Center

End Stage Renal Disease Facilities (TOB 72x):

• Payable services are denied for a reason such as overlap and only services that remain not denied are Status ‘N’ codes (packaged item or service):
  • Review line-item denials on claims
• For DDE users:
  • To determine the line item denial, go to Page 2 of your claim and press F2 to access the line levels. Press F6 to page through each line of the claim if necessary