RESOLVED: End-Stage Renal Disease Influenza Vaccine Claim Hold

Published 02/04/2025

RESOLVED: End Stage Renal Disease (ESRD) Influenza Vaccine Claim Hold
Current Status Date  
Resolved February 4, 2025 The Integrated Outpatient Code Editor (IOCE) fix was implemented with the January release. All stand-alone claims filed with CPT® code 90658 have been processed. Providers may continue normal monthly billing practices.

Open

November 8, 2024

Status: ESRD monthly claims are returned to provider (RTP) instructing providers to remove CPT® code 90658 and its administration code and bill them on a separate stand-alone claim. MACs will hold these stand-alone claims and adjustments until the IOCE release is implemented in January 2025.

Provider Action: Providers should bill CPT® code 90658 and administration code as a stand-alone claim to be held until the January 2025 release fix. Once you remove CPT® code 90658 and administration code from the monthly claim it may returned (F9) to process.

Issue Description

The Centers for Medicare & Medicaid Services (CMS) notified MACs the Integrated Outpatient Code Editor does not bypass but instead suspends claims with CPT® code 90658 Influenza vaccine. ESRD monthly claims may be returned to the provider instructing providers to remove CPT® code 90658 and its administration code and bill them on a separate stand-alone claim to be held until the IOCE release is implemented in January 2025.

 


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