Updated: Claims Processing Error in ESRD Related Services for Dialysis: CPT Codes 90951 - 90962
States Applicable: American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands, Northern California and Southern California
Background Information: Providers may bill either the monthly Home Dialysis ESRD codes (90963 – 90966) or the daily Other than Home Dialysis ESRD codes (90951 – 90962), but not both.
Procedure codes 90967 - 90970 were set up wrong in the system causing procedure codes 90951 - 90962 to deny when billed in the same month and claims may be denying in error.
Applies To Procedure Code(s):
90951 through 90962
Remark /Reason Codes:
B13 - Previously paid. Payment for this claim/service may have been provided in a previous payment.
M86 - Service denied because payment already made for same/similar procedure within set time frame.
MAC Action: A mass adjustment was performed and completed on April 20, 2009.
Provider Action: No Action Needed.
Date Reported: April 1, 2009
Date Resolved: April 20, 2009