CMS Pub. 100-04, ch. 31, § 20.7

Claim Status Codes for Use with the Health Care Claim Status Request

and Response ASC X12 276/277 Claim Status Request and Response

(Rev. 10236, Issued: 07-31-2020, Effective: 08-31-2020, Implementation: 08-31-2020)

Under HIPAA, all payers must use health care claim status category codes and health

care claim status codes approved by the Health Care Code Maintenance Committee as

applicable. At each ASC X12 trimester meeting (generally held the months of February,

June and October), the Committee may update the claim status category codes and the

claim status codes. When instructed, Medicare contractors must update their claims

systems to assure that the current version of these codes is used in their claim status

responses. The codes sets are available at the official Washington Publishing Company

website. Included in the code lists are specific details, including the date when a code

was added, changed or deleted.

CMS will issue recurring, one-time change requests regarding the need for and deadline

for future updates to these codes. Contractor and shared system changes will be made as

necessary as part of a routine release to reflect applicable changes such as retirement of

previously used codes or newly created codes that may impact Medicare. Shortly after

the release of each code update, a provider education article will be available at

http://www.cms.hhs.gov/medlearn/matters for contractors to use to conduct provider

outreach.