States Applicable to Alert: Nevada, Hawaii, Guam, American Samoa and Northern Marianna Islands.
Background Information: Due to an incorrect system update to CPT code 93228, a processing error occurred with claims in the specified areas above. The error excluded this procedure code from being payable to several provider types that would normally be permitted to bill the service. Claims have been denied in error since April 15, 2009.
Modifiers: Not Applicable
Remark/Reason Codes: B7 - This provider was not certified/eligible to be paid for this procedure/service
MAC Action: The system is being updated so the excluded providers will be allowed to bill the service. A mass adjustment will be performed once the system is updated. In the NV/HI environment/system, there were 20 claims mass adjusted.
Provider Action: None
Date Reported: September 3, 2009
Date Resolved:September 18, 2009