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Printed Date: 9/22/2015
Situation Identified November 29, 2018
Change Request 10851 (PDF, 89 KB) dated November 2, 2018, included additional changes to the 72X type of Bill (TOB). The Centers for Medicare & Medicaid Services (CMS) stated that dialysis treatments reported with the CG modifier and non-covered dialysis treatments should not be used for purposes of the TDAPA or outlier calculations. For purposes of the number of dialysis treatments for the month used in the TDAPA and outlier calculations, MACs should only consider those treatments that are reported and covered.
Impact to Provider:
Palmetto GBA will mass adjust ESRD 72X TOB claims as indicated below:
3/27/2019: Resolved. Palmetto GBA has completed the mass adjustment and there are no further issues.
11/29/2018: Palmetto GBA will mass adjust ESRD 72X TOB claims.
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Last Updated: 03/27/2019