EPC for Billing Codes Paid with Inactive Modifier 8A

Effective retroactively for dates of service on or after October 1, 2012, the Department of Health Care Services (DHCS) will implement an Erroneous Payment Correction (EPC) in 2014 to recoup payment awarded to providers for a service submitted with inactive modifier 8A. Even though modifier 8A has been inactive, partial payment has been awarded for claims with the modifier. The EPC will recoup the partial payment granted in error. Providers are encouraged to resubmit their claims with the appropriate CPT code 81220 (CFTR [cystic fibrosis transmembrane conductance regulator] [e.g., cystic fibrosis] gene analysis; common variants [e.g., ACMG/ACOG guidelines]). Providers are reminded that timeliness for these resubmitted claims is in effect.