EPC Letter – P40256: Resubmission of Erroneously Denied Radiology and Pathology Claims

(DHCS) identified a claims processing issue affecting certain claims billed for Radiology and Pathology services. This issue caused some claims to erroneously deny with Remittance Advice Details (RAD) code 0090: The combination of procedure code and modifier is not valid on the dates of service billed. The issue affected claims for dates of service from October 1, 2015, through December 29, 2019. No action is required on your part. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will resubmit the affected claims. These resubmissions will appear on RAD forms beginning March 26, 2020, with Claim Control Number (CCN) roll number 55 (Resubmit). The roll number is the fifth and sixth digits of the CCN.