Reason Code 31992

Published 07/20/2026

Description
Charges on this line were submitted as noncovered by the provider the Type of Bill (TOB) is equal to inpatient (11X, 18X, 21X or 41X), the non-covered charges are greater than zero and are equal to the total charges, and span code 79 or M1 is not present.

Another reason is that the Direct Data Entry (DDE)/Electronic Medical Coding (EMC) non-inpatient claim has line(s) with provider submitted non-covered charges greater than zero and is equal to the total charges, and condition code 20 or 21 is present.

Resolution
To ensure correct processing of your claim, please consider the following:

  • Determine if you expect payment from the claim or should the claim be a no-pay claim
  • Review the claim and ensure that the charges have been keyed into the correct column. Ensure that the coding and billing of the claim follows Medicare billing guidelines for the TOB.
    • Covered charge — The provider is expecting a payment
    • Non-covered charge — The provider is reporting the charge, but no payment is expected

References


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