Reason Code Help Tool

Published 08/15/2025

Disclaimer: This lookup tool does not contain all reason codes found in the Direct Data Entry (DDE) Reason Code file. Please refer to Section 5: Claims Corrections (PDF) of the DDE Guide for additional information. Reason codes may be added and are subject to change based on quarterly claim submission error data analysis.

This Reason Code Help Tool is designed to aid you in reviewing, understanding, and resolving the most frequent reason codes, or for determining if other actions are needed. You may search the tool by reason code, keyword or phrase. All records matching your search criteria will be returned for your review. You may also use the “Show All” button to view a complete list of reason codes available.

Questions pertaining to individual claims must be directed to the Provider Contact Center. You may fax a Written Inquiry Request form (PDF) to have your inquiry answered. Please do not include any Protected Health Information.

Remember, providers are responsible for determining the correct diagnostic and procedural coding for the services provided to Medicare patients. After reviewing Medicare guidelines, providers, compliance, audit and/or billing staff can find more information on coding resources in the CMS Internet-Only Manual (IOM) Publication 100-09, Chapter 6, Section 30.1.1 (PDF).

If you have a question about interpretation of procedural and diagnostic coding, please contact the entities that have responsibility for those coding sets.

  • Current Procedural Terminology (CPT®) codes are proprietary to the American Medical Association (AMA). As such, CPT® coding questions should be referred to the AMA. The AMA offers CPT® Information Services (CPT-IS). This internet-based service is a benefit to AMA members and is available as a subscription fee-based service for non-members and nonphysicians. The AMA also offers CPT® Assistant. Information about these resources is found on the AMA's website.
     
  • The American Hospital Association (AHA) has a website with many resources for answers to coding questions. The website also has a direct link to the AHA Coding Clinic whereby coding questions may be submitted and tracked.
     
  • Level II Healthcare Common Procedure Coding System (HCPCS) codes related to durable medical equipment or prosthetics, orthotics, and supplies are answered by the Pricing, Data Analysis and Coding (PDAC) Contractor. Information about the PDAC Contractor and the services it provides can be found on the PDAC's website
     
  • Additional information can be found about these resources on the CMS HCPCS General Information web page

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