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Claims Processing Issues Log
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 |
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 |
Open |
Outpatient claims |
W7092 |
HCPCS codes C1052, C1062, C1734, C1824, C1825, C1839, C1982 and C2596 |
|
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 |
Open |
Outpatient claims |
|
HCPCS codes G2066, 93297 or 93298 |
|
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. |
|
08.07.2023 |
Non-OPPS claims returned to provider (RTP'd) with reason code W7048 in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Non-OPPS claims |
W7048 |
Claims received on or after July 1, 2023 |
01.02.2024 |
MAC Action |
CGS will override reason code W7048 until the system update is implemented in January 2024. |
Provider Action |
You may F9/resubmit claims that RTP'd in error. |
Proposed Resolution |
01.02.2024 – A system correction was installed.
A system update is scheduled with the January 2024 release. |
|
07.03.2023 |
Some claims for audiologists who furnished certain diagnostic tests without a physician order returned to provider (RTP'd) in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Various Outpatient TOBs |
34963 |
Claims received on or after April 1, 2023, with modifier AB on all lines |
01.02.2024 |
MAC Action |
When all lines on the claim contain modifier AB, CGS will override reason code 34963 until the system update is implemented in January 2024. |
Provider Action |
Review claims that received reason code 34963.
- If modifier AB is reported on all claim lines, F9/resubmit the claim.
- If the claim also includes codes/lines without modifier AB, report the attending provider's name and NPI.
- If modifier AB is not reported on any claim lines, determine if it's appropriate to report modifier AB and/or the attending provider's name and NPI.
NOTE: An audiologist is not a valid attending provider. Please reference the CMS MLN Matters articles MM12889 (reason code 34963) and MM13055 (modifier AB) for additional information. |
Proposed Resolution |
01.02.2024 – A system correction was installed.
A system update is scheduled with the January 2024 quarterly release. |
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