code N110 and FIs/A MACs will use reason code B7.
Similarly, Medicare contractors will deny the claim if it contains a digital mammography HCPCS code and the facility is certified for film mammography only. In denying these claims because the facility is not certified to perform digital mammography, they will again use MSN message 16.2. In this instance:
- Carriers/B MACs will use:
- RA reason code 171 (Payment is denied when performed/billed by this type of provider in this type of facility) and
- Remark code N92 (This facility is not certified for digital mammography).
- FIs/A MACs will use reason code B7
- Carriers/B MACs will continue to use the MQSA file to verify the facility's FDA-assigned 6-digit certification number submitted on the claim, and will return claims to the supplier as unprocessable if it does not contain the facility's certification number.
Additional Information You can find the official instruction, CR 5577, issued to your carrier, FI, or A/B MAC by visiting
http://www.cms.hhs.gov/Transmittals/downloads/R1387CP.pdf. Additionally, you can find the revised sections of the
Medicare Claims Processing Manual, Chapter 18 (Preventive and Screening Services), Section 20.2 (HCPCS and Diagnosis Codes for Mammography Services) as an attachment to CR 5577.
If you have any questions, please contact our office at 1-888-828-2092.