Question 1

What is a Medicare ADR reason code?

Accepted Answer

Medicare ADR reason codes are assigned by Medicare Administrative Contractors to explain why a claim was selected for audit or denied. Each code corresponds to a specific documentation requirement or compliance issue that must be addressed in your ADR response.

Question 2

What is the most common hospice ADR denial code in 2026?

Accepted Answer

Code 5PM01 (Terminal Prognosis Not Supported) and 5PC08 (Face-to-Face Requirement Not Met) are among the most common in 2026, followed by 5PX06 for Election Statement Addendum issues related to new 2026 CMS requirements.

Question 3

How long do I have to respond to an ADR reason code?

Accepted Answer

Hospice agencies have 45 days to respond. Documentation must be received by the MAC within 45 days of the ADR date -- not simply mailed by day 45. Missing this deadline results in automatic denial.

Question 4

What should I do if I receive reason code 39700?

Accepted Answer

Code 39700 means your claim has been selected for prepayment review. Submit your complete medical record for the benefit period within 45 days. Start gathering documentation immediately upon receipt.

Question 5

Can I appeal a denial from an ADR reason code?

Accepted Answer

Yes. Most Medicare ADR denials can be appealed through the Redetermination process (Level 1 Appeal). You have 120 days from the denial date to file. Strong organized documentation is critical to appeal success.

Question 6

Are these reason codes updated for 2026?

Accepted Answer

Yes. This decoder covers the most current 2026 Medicare reason codes used by MACs in hospice ADR reviews including codes related to new HOPE reporting requirements and updated Election Statement Addendum requirements.

Hospice ADR Reason Code Decoder

2026 Most Common Hospice ADR Reason Codes

MR ADR Generated -- Prepayment Review

Face-to-Face Encounter Requirement Not Met

Invalid Election Statement -- 2026 Addendum Issue

Documentation Not Received -- Untimely Response

Terminal Prognosis Not Supported

Missing or Incomplete Certification of Terminal Illness

Claim Submitted for Non-Covered Service

Missing Notice of Election -- NOE Filing Issue

One Code Decoded. Hundreds More on Every Claim.

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