2019 OPPS Pricer Re-release and Claims Reprocessing

 Current Status

3/5/2019: Palmetto GBA is adjusting claims for Line Item Dates Of Service (LIDOS) in 2018 that contain a HCPCS code of 76706, 76977, 77078, 77080 and 77081 that contain a modifier of FX or FY that were processed prior to implementation of the release of the revised 2019 OPPS Pricer on February 18, 2019.

Palmetto GBA is also adjusting claims with a LIDOS in 2018 for providers that have a 2018 wage index outmigration adjustment that were processed in 2019 prior to implementation of the release of the revised 2019 OPPS Pricer. 

Please note that these adjustments are identified with 'T182' in the Direct Data Entry (DDE) Remarks field.

Situation:
CMS instructed MACs to reprocess claims with a LIDOS in 2018 for providers that have a 2018 wage index outmigration adjustment that were processed in 2019 prior to implementation of the release of the revised 2019 OPPS Pricer. MACs to initiate adjustments within 45 days of the installation of the revised 2019 OPPS Pricer.

Current Status

3/5/2019: Palmetto GBA is adjusting claims for Line Item Dates Of Service (LIDOS) in 2018 that contain a HCPCS code of 76706, 76977, 77078, 77080 and 77081 that contain a modifier of FX or FY that were processed prior to implementation of the release of the revised 2019 OPPS Pricer on February 18, 2019.

Palmetto GBA is also adjusting claims with a LIDOS in 2018 for providers that have a 2018 wage index outmigration adjustment that were processed in 2019 prior to implementation of the release of the revised 2019 OPPS Pricer. 

Please note that these adjustments are identified with ‘T182' in the Direct Data Entry (DDE) Remarks field.

2/28/2019: Palmetto GBA is adjusting claims for Line Item Dates Of Service (LIDOS) in 2018 that contain a HCPCS code of 76706, 76977, 77078, 77080 and 77081 that contain a modifier of FX or FY that were processed prior to implementation of the release of the revised 2019 OPPS Pricer on February 18, 2019.

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