Reason Code: U5181

Error Description:

Per the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Section 30.3, occurrence code 27 is reported on the claim for the billing period in which the certification or recertification was obtained. Therefore:

• If the certification/recertification was done prior to the service dates on the claim, an occurrence code 27 is not appropriate
  or
• When the claim dates of service are spanning a current election period, the occurrence code 27 date must equal the start date of the next election period. (Note that the occurrence code 27 date will create the next election period if one is not currently present.)
  or
• If billing an occurrence code 27 date for a late recertification, an occurrence span code 77 must also be present for the days that are prior to the late recertification date.

Avoiding/Correcting This Error

Ensure the usage of an appropriate certification or recertification date in accordance with occurrence code 27.

Related Content

• Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence Span Code 77 Job Aid
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11 (428 KB)