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Claim Payment Alerts
Please reference this page for information about confirmed, system-related claims processing issues before you reach out to the Provider Contact Center. Click on the description to view details and check back often for updates that we post when they become available.
Closed issues remain on the active log for approximately 60 days before they move to the resolved issues archive list at the bottom of the page.
If you still have questions, please contact the Provider Contact Center or use one of our self-service tools.
Date Reported |
Description of Issue |
04.23.2024 |
An incorrect status indicator assigned to outpatient claims with a line-item date of service on or after 1.1.2024 and CPT code 0621T or HCPCS code J7353. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Outpatient claims |
|
LIDOS on or after 1.1.2024 and CPT code 0621T or HCPCS code J7353 |
|
MAC Action |
CGS will:
- Suspend claims to apply a workaround until the system update is implemented in July 2024
- Adjust claims when brought to our attention
|
Provider Action |
N/A
|
Proposed Resolution |
CMS will correct errors to codes 0621T, J7353 and C9167 in the July 2024 Hospital Outpatient Prospective Payment System update. See the MLN Connects Newsletter: April 25, 2024, for details. |
|
02.21.2024 |
Reason Code W7092: Effective January 1, 2024, outpatient claims submitted with certain procedure codes returned to provider (RTP’d) for missing a device code in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Outpatient claims |
W7092 |
HCPCS codes C1052, C1062, C1734, C1824, C1825, C1839, C1982 and C2596 |
04.01.2024 |
MAC Action |
CGS will suspend claims to status/location (S/LOC) S M7092 to apply a workaround until the system update is implemented (scheduled in April 2024). |
Provider Action |
You may F9/resubmit any RTP claims you identify for CGS to apply the workaround. |
Proposed Resolution |
A system update is scheduled with the April 2024 release. |
|
02.08.2024 |
Claims submitted with HCPCS codes G2066, 93297 or 93298 will return to provider (RTP) until a system correction is installed. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Outpatient claims |
|
HCPCS codes G2066, 93297 or 93298 |
04.01.2024 |
MAC Action |
|
Provider Action |
- We encourage you to hold claims for these services until the system correction is installed (scheduled in April).
- If you choose to submit claims prior to April, you may F9/resubmit any RTP claims you identify after the system correction is installed.
|
Proposed Resolution |
Effective, January 1, 2024, claims for these services will RTP due to the following:
- HCPCS code G2066 terminated on 12.31.2023.
- CPT codes 93297 and 93298 assign to status indicator M (Items and services not billable to the MAC; not paid under OPPS).
A system correction is scheduled for the April 2024 release. Once installed, CPT codes 93297 and 93298 will assign to a separately payable status indicator (Q1) and APC 5741, effective January 1, 2024. |
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