J15 Part A Claims Processing Issues Log
Listed below are current system-related claims processing issues that have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS) Maintainer. This information is made available and updated as we have new information or updates to share, so you may review prior to contacting the Part A Provider Contact Center. A list of resolved issues is also available at the end of this list. If you still have questions, please call 866.590.6703.
|Reason Code/Status Location
|Healthcare Common Procedure Coding System (HCPCS) 77063 – screening digital tomosynthesis
||Outpatient claims (Type of Bill 12x and 13x) submitted with screening digital tomosynthesis (HCPCS) 77063 are not pricing based of the Medicare Physician Fee Schedule (MPFS) when billed correctly.
A tentative correction date is scheduled to correct the issue when the October release goes into production on October 5, 2015. CGS will mass adjust claims or adjust claims brought to their attention.
|36602, 36381 Status Location SMG279
||HCPCS code G0279 (diagnostic digital breast tomosynthesis, unilateral or bilateral) is not pricing when submitted on claims.
It has been determined that the July release will not fully correct the problems associated with the claims. CMS has instructed CGS to release the held claims, process them and append condition code 15. When the correction is implemented in January 2016, the claims will be adjusted to process and pay correctly.
A tentative correction date is scheduled when the July release is implemented. Suspended claims will be released to process.
There are still issues with pricing of the codes.
There are ongoing issues with the pricing of the codes. CMS has advised contractors to continue to hold claims until further notice.
Claims with HCPCS codes G0279 or G0280 will be suspended in location SMG279 and SMG280 until the FISS April Quarterly Release, scheduled to go into production on 04.06.15, is implemented. There is no workaround. Once the release is implemented, suspended claims will be released by CGS.