Procedure Inconsistent With LOS ICD-10-PCS
The procedure inconsistent with los edit is a coverage check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 1 ICD-10-PCS procedure code listed below. This ventilation code may only be reported when respiratory ventilation is provided for more than four consecutive days during the stay. On shorter stays the MCE flags the claim as inconsistent with the length of stay.
Procedure Codes in This Edit 1 code · 1 category
Physiological Systems1 code
- 5A1955Z Respiratory Ventilation, Greater than 96 Consecutive Hours
Questions About This Code Edit
What is the procedure inconsistent with los Medicare code edit?
The following procedure code should only be coded on claims when the respiratory ventilation is provided for greater than four consecutive days during the length of stay. The Medicare Code Editor flags any inpatient claim that triggers the check.
How many codes are on the procedure inconsistent with los list?
The FY 2026 list contains 1 code, imported from the CMS Definitions of Medicare Code Edits v43.0.
What happens when a claim triggers this edit?
This ventilation code may only be reported when respiratory ventilation is provided for more than four consecutive days during the stay. On shorter stays the MCE flags the claim as inconsistent with the length of stay.
Does this edit make the codes invalid?
No. Every code on this list is a valid code. The edit is about Medicare payment rules, not about whether the code exists or can be documented.
Other ICD-10-PCS Medicare Code Edits
Source: CMS Definitions of Medicare Code Edits v43.0, effective October 1, 2025 through September 30, 2026. Code lists are imported directly from the official manual. See also the ICD-10-CM diagnosis edits and the MS-DRG list.
