Medi-Cal Claims Processing Issue with Global Split-Billable Procedure Code

The Department of Health Care Services (DHCS) is aware of a claims processing issue affecting global services with split-billable procedure codes billed with a single valid modifier other than TC (technical component) or 26 (professional component). This issue affects claims submitted for dates of service on or after August 1, 2015. These claims are receiving Remittance Advice Detail (RAD) code 0196: This procedure requires a modifier; modifier is not present. DHCS is working to resolve this issue. Impacted providers do not need to take any action on these denials. The affected claims will be reprocessed with an Erroneous Payment Correction (EPC). Providers must continue submitting their claims to keep the claims timely.