Reason Code: 39910

This claim was returned for one or more of the following reasons:

Modifier CD, CE or CF on claim TOB require a 72X TOB
Revenue code 881 does not require HCPCS code
RHC (TOB 71X) claims require the CG modifier on revenue code lines 52X or 900
Refer to MLN Matters® SE1611: Rural Health Clinics (RHCs) Healthcare Common Procedure Coding System (HCPCS) Reporting Requirement and Billing Updates
RHC (TOB 71X) and FQHC (TOB 77X) claims should not be billed with charges for vaccines. When billed without a qualifying visit, vaccine administration is not a billable visit.
TOB 12X is not a valid bill type for HCPCS code G9141 for billing vaccines, H1N1, or any flu vaccine codes.
Revenue code 651, 652, 655 or 656 is required on an 81X or 82X bill type.
When billing for a same-day transfer, the following information is required: same admission from and through dates are the same. Patient status is 02, 03 or 04 and condition code 40 is included on the claim.
SNF/SB PDPM claim following interrupted stay or non-skilled level of care stay greater than three days requires a new assessment and new admission date.

Verify billing. If appropriate, correct and resubmit the claim.