Adjustment Reason

Adjustment reason codes are required on DDE adjustments (TOB XX7) and are entered on page 3. Adjustment Reason Codes are not used on paper or electronic claims.

Code Description 

AA   Automated Adjustment 

AD   Admission Denial - Technical Denial (PRO Review Code - A) 

AM Admission Denial - No Payment (Medical Denial) (PRO Review Code - A) 

AR Admission Reversal - Hard Copy Adjustment 

AW Admission Denial-Payable Per Waiver 

CA Cost Outlier Approved 

CB This Reason Code will be to Identify Credit Balance Accounts 

CC Covered Charges Changes 

CD Covered Days Changes (PRO Review Code - B) 

CO Cost Outlier - No Payment (PRO Review Code - E) 

CP Cost Outlier Partial Approved 

CR Claim Reconsideration 

CW Cost Outlier Denial-Payable Per Waiver 

DA Day Outlier Approved  

DC Diagnosis Changes (PRO Review Code - C) 

DD Discharge Destination Code Changes (PRO Review Code - C) 

DG DRG Change and Day Outlier Denial (PRO Review Code - G) 

DH DRG Change and Cost Outlier Denial (PRO Review Code - H) 

DI DRG and Beneficiary Liability Change (PRO Review Code - I) 

DO Day Outlier Denial - No Payment (PRO Review Code - D) 

DP Diagnosis and Procedure Changes (PRO Review Code - C) 

DS Discharge Status Change DV DRG Validation (PRO Review Code - C) 

DW Day Outlier Denial-Payable Per Waiver 

EF ESRD Adjustment Fix to Correct Original Claims

 FB Beneficiary Liability Change (PRO Review Code - F) 

FC HHPPS Final claim 

FD Full Denial (PRO Review Code - A) 

FR Full Reversal (PRO Review Code - N) 

FT Full Denial - Technical Denial (PRO Review Code - A) 

HA Home Health 485/486 Post-payment Audits 

HC Home Health Covered Compliance Reviews 

HD HMO Disenrollment 

HP HMO Pay

 IB PPS Interim Bill IC Non-Billable Revenue Codes Invalid Revenue Codes 

ID Inpatient or Blood Deductible 

JP Deemed Admission Change in Days (PRO Review Code - J) 

KB Deemed Admission Change in Days (PRO Review Code - J) 

KD Deemed Admission/Diagnosis Code Change (PRO Review Code - K) 

KP Deemed Admission/Procedure Code Change (PRO Review Code - K) 

LD Deemed Admission/Day Outlier Denial (PRO Review Code - L) 

LI Liability 

LS Length of Stay Denial-No Payment 

LW Length of Stay Denial-Payable Per Waiver 

MC Deemed Admission/Cost Outlier Denial (PRO Review Code - M) 

NF HHPPS No Final Claim 

OC Procedure Codes Changed, Denied, or Added (PRO Review Code - R) 

OP Day Outlier Approved 

OT Other Change 

PC Procedure Changes (PRO Review Code - C) 

PD Procedural Denial - No Payment 

PI Program Integrity 

PN Provider Number Change 

PP Discharge Status Change (PRO Review Code - P) 

PR Previous Adjustment Modifi ed (Modifies the PROs Last Action) (PRO Review Code - O) 

PT Admission Denial and D

RG Change (PRO Review Code - T) 

PW Procedural Denial - Payable Per Waiver 

QC Procedure Codes (HCPCS) Changed/Deleted/Added (PRO Review Code - R) 

QD Ancillary Services Denied or Approved (PRO Review Code - Q) 

QR HCPC Added/Deleted/Changed with Ancillary Change (PRO Review Code-S) 

RI Recovery Audit Contractor (RAC) Identifi ed Overpayment 

RC Complete Reversal of Previous Adjustment (PRO Review Code - N) 

RP Partial Reversal of Previous Adjustment (PRO Review Code - O) 

SB Same Benefi t Period 

SD Seven Day Readmission Denial 

SW Seven Day Re-admission Denial - Payable Per Waiver 

TD Transfer Denial - No Payment 

TW Transfer Denial - Payable Per Waiver 

YA Pacemaker Denial - No Data 

YB Pacemaker Denial - With Errors 

YC Pacemaker Reversal to Denial 

YD Pacemaker Reversal to Denial and not going to pay 

ZW Debit Adjustment being processed for Provider and Intermediary and an initial bill is being processed to CWF