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Reason Code 31428

Published 09/25/2025

Reason Code Description

For a hospice 81x or 82x type of bill, an invalid revenue and Healthcare Common Procedure Coding System (HCPCS) code combination was reported on the claim. Please review the revenue and HCPCS code combinations reported on the claim, make corrections and resubmit the claim for processing.

Why the Reason Code was Assigned

At least one invalid revenue and HCPCS code combination was reported on the claim. For example, revenue code 0551 (skilled nursing) is billed with HCPCS code G0156 (aide). This is an invalid reporting combination and would cause the claim to return to the provider with Reason Code 31428.

Resolution

Review the revenue code and HCPCS code combinations reported on the claim, make corrections and resubmit the claim for processing. 

The following chart provides example code combinations, but hospices may view Section 30.3 — Data Required on the Institutional Claim to A/B MAC (HHH) of the Hospice Medicare Claims Processing Manual or Palmetto GBA’s Hospice Billing Codes Job Aid for additional coding information (links are in the reference section below). 

Revenue Codes HCPCS Codes
042X (physical therapy) G0151 or G0157
043X (occupational therapy) G0152 or G0158
044X (speech-language pathology) G0153
055X (skilled nursing) G0299 (RN)
G0300 (LPN)
056X (medical social services)
0569 (other medical social services — phone call)
G0155
057X (Aide) G0156
651, 652, 655 and 656 (levels of care) Q5001–Q5010 (service locations)

Resources


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