RESOLVED: Some Home Health Claims Editing for Reason Code 37257, Federal Information Processing Standards County Code Missing or Invalid

Published 03/13/2025

RESOLVED: Home Health (HH) — Some Claims Editing for Reason Code 37257, Federal Information Processing Standards (FIPS) County Code Missing or Invalid
Current Status Date  
Resolved March 12, 2025 Status: A fix to this issue was implemented on March 11, 2025, as the Pricier was updated. 

Provider Action: HH agencies need to return the claims for processing that were affected by this issue. 

Please ensure that correct FIPS/Core Based Statistical Area (CBSA) coding is entered on your HH claims or they may be returned for reason code 37257. Resources for finding FIPS/CBSA coding are located in the article: Reporting Federal Information Processing Standards State and County Codes on Home Health Claims Is Required.

Open February 25, 2025 Status: This issue is in research.

Provider Action: HH agencies need to ensure they are reporting correct FIPS and CBSA coding on their claims, as they may change in a new fiscal year. Resources for finding FIPS/CBSA coding are located in the article: Reporting Federal Information Processing Standards State and County Codes on Home Health Claims Is Required.

No additional provider actions are needed at this time. We will provide an update as soon as it is available.

Issue Description

For some 2025 HH claims, the HH Pricer is returning reason code 37257.  This reason codes notes that the FIPS County Code is missing or invalid. This is occurring for HH claims that changed from urban CBSA in calendar year 2024 to rural CBSA in 2025.

HH services billed on TOB 032x are reimbursed based on calculations made by the HH Pricer. The HH Pricer makes all payment calculations applicable under HH PPS. Medicare claims processing systems send an input record to Pricer for all claims with covered visits, and Pricer will return an output record to the shared systems. For this issue, the Pricer payment return codes for this issue are returning code 31, Invalid/Missing County Code.

 

 

 


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