Billing codes are updated each year by the American Medical Association. Please refer to the 2020 manuals for Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS).
We’re now updating our systems for new 2020 codes. Claims submitted with new codes for covered services will be noted on the explanation of payment (EOP) statements with an explanation code of Z0 that states “New code, rate not yet established, will be adjudicated by March 31, 2020.” This applies to commercial claims.
We will automatically adjust commercial claims submitted with old codes between Jan. 1, 2020 and March 31, 2020 to new, covered codes. Providers do not need to resubmit claims. When adjustments are made and claims paid, EOPs will inform providers that the payment includes adjustment of the new codes that paid $0 upon initial submission.
Medicare claims containing a new code will be paid when the new 2020 codes are configured. We will also automatically adjust Medicare claims submitted between January and the date when the 2020 codes have been configured with new, covered codes. Medicare providers do not need to resubmit claims. When adjustments are made and claims paid, EOPs will inform providers that the payment includes adjustment of the new codes.