Claims edits that go into effect June 26, 2018

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Claims edits that go into effect June 26, 2018


The following claims edits will go into effect June 26, 2018:

Policy Description What plans are affected?
Care management services Care management CPT codes 99487, 99489-99490 are payable only when billed with a primary and a secondary diagnosis.

Reference: AMA CPT code full descriptions

Commercial and Medicare Advantage
Routine foot care frequency Routine Foot Care CPT codes 11055-11057, 11719-11721 or G0127 will not be payable if billed more than once within a two-month period.

Reference: NGS Medicare LCD L33636

Commercial and Medicare Advantage
Corneal pachymetry CPT 76514 (Ophthalmic ultrasound, diagnostic; corneal pachymetry) will not be payable when billed more than once in a patient's lifetime with a diagnosis of glaucoma or ocular hypertension (OHT).

Reference: NGS Medicare LCD L33630

Medicare Advantage only