Claims Adjustments with Procedure Codes 0190T, 0191T and 0192T When Performed in An ASC - Update
States Applicable to Alert: California, Hawaii, Nevada, Guam, the Northern Mariana Islands and American Samoa
Background Information: Claims were denied in error because these procedure codes were not set up in the system to be performed in an ASC.
Applies To Procedure Code(s): 0190T, 0191T and 0192T
Modifier(s): Modifier SG prior to January 1, 2008. No modifier is required for dates of service since January 1, 2008.
Remark /Reason Codes:
171 - Payment is denied when performed or billed by this type of provider in this type of facility.
M97 - Not paid to practitioner when provided to patient in such place of service. Payment is included in the reimbursement issued to the facility.
MAC Action: System maintenance was completed and a mass adjustment was performed for TOS F, Specialty 49 providers. No claims were found. System maintenance and a mass adjustment is pending for all other specialties.
Provider Action: No action required.
Date Reported: February 2, 2009
Date Resolved: Resolved for Specialty 49 on July 17, 2009.