Claims

The Centers for Medicare & Medicaid Services (CMS) has announced it discovered systems errors affecting claims with new drug testing laboratory codes (HCPCS codes G0477 through G0483) with dates of service on or after January 1, 2016.

If you are affected, CMS states that your Medicare Administrative Contractor (MAC) will be holding these claims until April 4, 2016. No provider action is required.

Should you wish to avoid your claims from being held, you can remove codes G0477 through G0483 and submit the rest of the services on the claim, CMS notes. When the system is updated in April, you can submit an adjustment claim to add these HCPCS codes. Your MAC will correct any claims previously returned to you in error with these codes and reason code W7006 after the system is updated.

The Centers for Medicare & Medicaid Services (CMS) has announced that coinsurance and deductible are not being waived on claims containing codes G0473 (intensive behavioral therapy for obesity) and 77063 (screening digital breast tomosynthesis, bilateral).

CMS notes the problem, a result of a systems error, will be corrected on April 6, 2015.

For claims with dates of service of January 1, 2015, through March 31, 2015, Medicare administrative contractors will be mass adjusting these claims and issuing corrected payments for all impacted claims.

CMS states providers must reimburse beneficiaries for any overpayment caused by this error.

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