CMS Pub. 100-04, ch. 1, § 130.1.2.1

The term Medicare beneficiary identifier (Mbi) is a general term describing a

beneficiary’s Medicare identification number. For purposes of this manual, Medicare

beneficiary identifier references both the Health Insurance Claim Number (HICN) and

the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition

period and after for certain business areas that will continue to use the HICN as part of

their processes.

The provider submits one of the following claim change reason codes to its FI with each

debit-only or cancel-only adjustment request:

Bill

Type

Reason

Code Explanation

Xx7 D0 (zero) Change to service dates

Xx7 D1 Change in charges

Xx7 D2 Change in revenue codes/HCPCS - HIPPS

Xx7 D3 Second or subsequent interim PPS bill - PPS inpatient hospital only

Xx7 D4 Change in GROUPER input (diagnoses or procedures) - PPS

inpatient hospital).

Xx8 D5 Cancel-only to correct a Medicare beneficiary identifier or provider

identification number

Xx8 D6 Cancel-only to repay a duplicate payment or OIG overpayment

(includes cancellation of an outpatient bill containing services

required to be included on the inpatient bill.)

Xx7 D7 Change to make Medicare the secondary payer

Xx7 D8 Change to make Medicare the primary payer

Xx7 D9 Any other change

Xx7 E0 (zero) Change in patient status

The provider may not submit more than one claim change reason code per adjustment

request. It must choose the single reason that best describes the adjustment it is

requesting. It should use claim change reason code D1 only when the charges are the

only change on the claim. Other claim change reasons frequently change charges, but the

provider may not “add” reason code D1 when this occurs.

The claim change reason code is entered as a condition code on the hard copy Form

CMS-1450 or the electronic equivalent. For reason codes D0-D4 and D7-D9, the biller

submits a debit-only adjustment request, bill type xx7. For reason codes D5 and D6, it

submits a cancel-only adjustment request, bill type xx8.