Resubmission of Claims for CPT Codes

The Indiana Health Coverage Programs (IHCP) has identified a claims processing issue that affects fee-for-service (FFS) claims billed for CPT codes 88361, 88374 and 88377. The affected claims are for dates of service (DOS) on or after July 1, 2015, and may have inappropriately denied with one of the following explanations of benefits (EOBs): 4209 – No pricing segment for procedure code/modifier combination or 6000 – Manual pricing required. Pricing information for these procedure codes will be corrected in the claims processing system so claims will adjudicate properly. Beginning March 2, 2016, providers may resubmit previously denied claims for the affected codes with DOS on or after July 1, 2015 for reimbursement consideration. Claims resubmitted beyond the original one-year filing limit must include a copy of this banner page as an attachment and must be filed within one year of the banner page’s publication date.