OPEN: Critical Access Hospital Professional Services Rejecting with 31006 and 31007

Published 08/19/2025

OPEN: Critical Access Hospital (CAH) Professional Services Rejecting with 31006 and 31007
Current Status Date   
Updated August 18, 2025

Status: Medicare Administrative Contractors (MACs) have reported this issue to the Shared System Maintainer to investigate further. An Office of Inspector General (OIG) audit identified that:

  • Both CAHs and practitioners received payment for the same professional services
  • Practitioners billed for services after they reassigned their billing rights to a CAH

Centers for Medicare & Medicaid Services (CMS) Change Request (CR) 13900 created edits to prevent duplicate billing. Effective for dates of service on or after July 1, 2025, Reason Code 31006 or 31007 will assign on CAH Method II (Type of Bill, TOB 85X) claim lines for professional services (revenue code 096X, 097X, or 098X) when:

  • The Attending or Rendering Physician NPI does not have a reassignment on file in PECOS
  • The line level date of service on the claim does not fall within the physician’s effective and term dates in PECOS
Provider Action: Providers must submit reassignment applications (CMS-855I, PDF) in PECOS for processing before January 1, 2026.
Open August 1, 2025 Status: MACs have reported this issue to the Shared System Maintainer to investigate further.
Provider Action: No provider action is required. Please do not submit appeals for this rejection.
Issue
CAH claims billed with professional services on revenue codes 96X, 97X and 98X are being rejected with Reason Codes 31006 and 31007 when the practitioner is reassigned to the CAH.

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