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FISS Narrative:
A 3D mammography claim is received by a facility not certified for 3D mammography using the following criteria: CPT code 77063 or HCPCS code G0279 is present on the claim and one or more of the following conditions exist:

  • A mammography termination date on MAP1108 is present in the TERM-DT field for 3D CERT and the statement covered date of the claim is greater that the mammography termination date
  • A mammography certification indicator on MAP1108 is not present
  • The mammography certification indicator on MAP1108 is equal to an N or space
  • The mammography certification indicator on MAP1108 is NOT equal to an N or space, and the statement covered from date of the claim falls outside the range of the mammography certification effective date and termination date

Guidelines and Suggestions
This edit is set to line reject if a certification is not listed on the provider file when a 3D mammography claim is billed to Medicare. For further information, please refer to Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-04, Chapter 18 - Preventive and Screening Services (PDF, 1.3 MB).

Submission of updated certificates may be faxed to Provider Reimbursement at 803-935-0262. Once the provider file is updated with the current certification date; the provider may resubmit the claim.

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