States Applicable to Alert: Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands, Northern California and Southern California
Background Information: Palmetto GBA has discovered that some of the Colorectal Cancer Screening procedure codes were being suspended for manual coverage review in error and some claims may have been processed and denied incorrectly.
Applies To Procedure Code(s): G0104, G0105, G0106 and G0120
Modifier(s): N/A
Remark /Reason Codes:
50 – These are non-covered services because this is not deemed a 'medical necessity' by the payer.
N115 – This decision was based on a Local Medical Review Policy (LMRP) or Local Coverage Determination (LCD). An LMPR/LCD provides a guide to assist in determining whether a particular item or service is covered.
A copy of this policy is available at www.cms.hhs.gov/mcd. If you do not have Web access, you may contact Palmetto GBA to request a copy of the LMRP/LCD.
MAC Action: Palmetto GBA has completed a mass adjustment and paid services denied in error. A total of seven claims were found and adjusted for Hawaii and Nevada. There were no claims found for adjustment in the California.
Provider Action: None
Date Reported: May 12, 2009
Date Resolved: June 23, 2009
last updated on 06/26/2009