CMS asks providers to discontinue the practice of routinely resubmitting duplicate claims. If you submit more than once for the same service on the same date of service, your claim will be denied as a duplicate. In addition, duplicate claims: may delay payment could cause you to be identified as an abusive biller if a pattern of duplicate billing is identified, may...
if a pattern of duplicate billing is identified, may generate an investigation for fraud Code Mod Description Amount 88358 Non-Facility PE RVU Facility PE RVU $58.91 88358 TC Non-Facility PE RVU Facility PE RVU $6.31 88358 26...
An article published in Medicare B Resource for June 2003 (page 21) announced that Medicare considered High sensitivity C-reactive protein to be used as a screening test only and therefore not reimbursable. This policy is being revised based on updated information. High sensitivity C-reactive protein (hsCRP) (CPT code 86141) has been found to be related to or somewhat predictive of atherogenic...
Effective for dates of service on or after September 1, 2004, providers may electronically bill for laboratory services (CPT-4 80000 series codes and HCPCS Level III codes) that require medical justification by entering the medical justification in the electronic filing Remarks area of the transaction. Medical justification statements entered in the electronic filing Remarks area must not exceed...
The HIPAA Transaction and Code Set Rule requires the use of national/medical code sets (such as ICD-9s) that are valid at the time the service is rendered. All claims for services on or after October 1, 2004 must adhere to the 2005 diagnosis code changes. In past years, ICD-9 codes became effective for Medi-Cal in January or February. Though code updates were released in October, Medi-Cal...