Resolved: Home Health Claims Editing for Reason Codes U5210/U5220

Some home health NOAs and claims were incorrectly hitting reason codes U5210 and U5220. These reason codes state there is no Medicare entitlement for the dates of service when the beneficiary only has Part B eligibility for the dates of service submitted.

Medicare’s entitlement to home health services only requires a beneficiary to have Medicare Part A or Part B, not both. If a beneficiary is enrolled only in Part A and qualifies for the Medicare home health benefit, all the home health services are financed under Part A. If a beneficiary is enrolled only in Part B and qualifies for the Medicare home health benefit, all of the home health services are financed under Part B.

This issue has been resolved as of 3/6/2023. Providers may resubmit any NOAs and claims that incorrectly rejected for U5210/U5220. If this issue has caused untimely submission of the NOA, providers may request a late NOA exception on the corresponding claim(s) by appending modifier KX to the HIPPS code on the 0023 revenue line and indicate the following in the Remarks field: “Late NOA due to U5210/U5220 issue.”

Posted 3/23/2023