States Applicable to Alert:
American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands, Northern California and Southern California
Background Information:
Incorrect ICD-9-CM codes were entered into the Palmetto GBA system for some CPT codes listed in the Allergy Testing LCD. As a result, the services may have been underpaid or overpaid since the J1 transition.
Applies To Procedure Codes:
Northern and Southern California: CPT code 86003
- If CPT code 86003 was submitted with ICD-9-CM code 995.20, the service may have been incorrectly denied
American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands: CPT codes 95044, 95052, 95056
- If CPT codes 95044, 95052 or 95056 was submitted with one of the following ICD-9-CM codes, the service may have been incorrectly paid:
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ICD-9-CM Codes
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372.14-372.14
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381.00-381.06
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381.10-381.10
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381.19-381.19
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381.3-381.3
|
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381.4-381.4
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381.50-381.52
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466.0-466.0
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471.0-471.0
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471.1-471.1
|
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471.8-471.8
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471.9-471.9
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472.0-472.0
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474.00-474.02
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474.10-474.12
|
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477.0-477.0
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477.1-477.1
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477.2-477.2
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477.8-477.8
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477.9-477.9
|
|
478.11-478.11
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478.19-478.19
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493.00-493.02
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49310-493.12
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493.20-493.22
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493.90-493.92
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599.82-599.82
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693.0-693.0
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693.1-693.1
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693.8-693.8
|
|
693.9-693.9
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708.0-708.0
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708.8-708.8
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708.9-708.9
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781.1-781.1
|
|
782.1-782.1
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786.00-786.00
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786.05-786.05
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786.07-786.07
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786.2-786.2
|
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989.5-989.5
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989.81-989.83
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989.89-989.89
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995.0-995.0
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995.1-995.1
|
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995.20-995.23
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995.27-995.27
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995.29-995.29
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995.3-995.3
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995.4-995.4
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995.60-995.69
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995.7-995.7
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|
|
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- If CPT codes 95044, 95052 or 95056 was submitted with one of the following ICD-9-CM codes, the service may have been incorrectly denied:
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ICD-9-CM Codes
|
|
277.1-277.1
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692.0-692.0
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692.1-692.1
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692.2-692.2 |
692.3-692.3 |
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692.4-692.4
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692.5-692.5
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692.6-692.6
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692.70-692.74
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692.79-692.79
|
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692.81-692.84
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692.89-692.89
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692.9-692.9
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695.89-695.89
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695.9-695.9
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705.81-705.81
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|
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|
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Modifier(s): Not Applicable
Remark /Reason Codes:
CARC (reason code) = 50
RARC (remark code) = N115
CO-15.4
MAC Action:
The Palmetto GBA system will be corrected. Mass adjustments have been completed to pay services incorrectly denied or recoup overpayment for services incorrectly paid.
- 95 HI/NV claims with CPT 95044, 95052 or 95056 were identified as underpaid
- Three HI/NV claims with CPT 95044, 95052 or 95056 were identified as overpaid
- Two Northern California and five Southern California claims with CPT 86003 were identified as overpaid
Provider Action: None required
Date Reported: August 27, 2009
Date Resolved: October 30, 2009