Non-Covered Days: Value Code 81 and Occurrence Code Reporting Requirements

To support accurate claims processing, providers should ensure that Medicare non-covered days are reported correctly.

Reporting Non-Covered Days

Non-covered days must be reported using Value Code 81. Non-covered days are days not covered by Medicare because Medicare benefits have been exhausted or the beneficiary no longer requires skilled care. When submitting a claim with Value Code 81, facilities are responsible for reporting the appropriate occurrence code and corresponding date based on the reason the Medicare days are non-covered.

When Medicare Benefits Are Exhausted

When non-covered days are reported because the beneficiary's Medicare benefits have been exhausted:

• Report Value Code 81.
• Report Occurrence Code A3.
• Include the date Medicare benefits were exhausted.

When Medicare Active Care Has Ended

When non-covered days are reported because Medicare active care has ended:

• Report Value Code 81.
• Report Occurrence Code 22.
• Include the corresponding date Medicare active care ended.

When Medicare Coverage Is Denied

When non-covered days are reported because Medicare coverage was denied:

• Report Value Code 81.
• Report Occurrence Code 24.

Important Reminder: Providers are responsible for ensuring that the appropriate Value Code and Occurrence Code are included on the claim. Claims may be subject to an edit when Value Code 81 is reported without the expected occurrence code, or when the required claim information is missing.

RARC M28: Indicates that Medicare Part A coverage has been exhausted or is otherwise unavailable, and the claim does not qualify for payment under Medicare Part B.