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Industry News: Railroad Medicare

Monday, May 03, 2010

Historically, pathology services associated with transperineal Prostate Saturation Biopsy (PSB) have been reported with CPT code 88305. CMS determined that separate billing for transperineal PSB samples resulted in significant overpayments for the amount of work involved in performing these services. Effective for dates of service on or after 1/1/2009, CMS implemented four new HCPCS codes to more accurately represent the pathologic evaluation, interpretation, and report for these services.

Thursday, January 07, 2010

Railroad Medicare has incorrectly denied claims for various procedures. The affected claims were processed between October 4 and December 14, 2009 and include CPT Codes 82000-84830; 80048-80076; 85002-85810 and 99840-99842. These codes were denied with the message text: 'M-76-These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.'

Railroad Medicare will automatically adjust these claims that were denied in error.