Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
This is an outpatient claim (Type of Bill 12X, 13X, or 14X) in which the Outpatient Prospective Payment System (OPPS) reimbursement is greater than the covered charges reported on the claim.
MLN Matters Article 7771 (PDF, 87 KB) created Reason Code 39132 as a verification edit for development. MACs will suspend those claims receiving this edit to determine billing accuracy and that the OPPS reimbursement is not excessive. The claim is returned to the provider (RTP) with Reason Code 39132 for provider verification.
Once verified and returned to the MAC, the claim will suspend to the Manual Location S MREM for review. If it is determined that the billing is accurate and the reimbursement is not excessive, the edit will be override and continue to process the claim.
*In most cases, the unit of payment under the OPPS is the APC. CMS assigns individual services (Healthcare Common Procedure Coding System [HCPCS] codes) to APCs based on similar clinical characteristics and similar costs. The payment rate and copayment calculated for an APC apply to each service within the APC.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 12/27/2018