Evaluation and Management Services vs. Chemotherapy Administrations and Non-Chemotherapy Drug Infusion & Drug Injection Services
Some claims for new 2009 CPT codes 96360, 96361, 96365 through 96368, and 96372 through 96375 may have been denied in error for dates of service January 1, 2009, through January 27, 2009.
The incorrect denials affected claims submitted with the following CPT codes:
- 92012 through 92014, 99201 through 99205, 99212 through 99215, 99217 through 99223, 99231 through 99236, 99238 through 99239, 99241 through 99245, 99251 through 99255, 99291 through 99292, 99304 through 99307, 99308 through 99310, 99315 through 99316, 99324 through 99328, 99318, 99334 through 99337 and/or 99347 through 99350, submitted with CPT modifier 25 and submitted on the same date of service as the following:
- CPT codes 96360, 96361, 96365, 96366, 96367, 96368, 96372, 96373, 96374 and/or 96375
Affected claims were denied with the following messages:
Reason code CO-97: Payment adjusted because the benefit for this service is included in the payment/allowance for another service/procedure that has already.
Remark code N20: Service not payable with other service rendered on the same date.
Palmetto GBA will automatically adjust claims that were denied incorrectly. These adjustments will take place once affected claims have finalized in the claims processing system. If you have questions regarding this issue, please contact the Provider Contact Center at (866) 332-7025.