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South Carolina Part B Carrier
Evaluation and Management Services vs Chemotherapy Administrations and Non-Chemotherapy Drug Infusion & Drug Injection Services

Some claims for new 2009 CPT codes 96360, 96361, 96365-96368, 96372-96375 may have been denied in error for dates of service 1/1/09 – 1/27/09.
 
The incorrect denials affected claims submitted with the following CPT codes:
  • 92012-92014, 99201-99205, 99212-99215, 99217-99223, 99231-99236, 99238-99239, 99241-99245, 99251-99255, 99291-99292, 99304-99307, 99308-99310, 99315-99316, 99324-99328, 99318, 99334-99337 and/or 99347-99350, submitted with CPT modifier 25, submitted on the same date of service as
  • 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 (888) 828-2092.

 

last updated on 02/09/2009
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