Medicare Mammography Payment Issue

    By: Amanda Shiber on Feb 01, 2018

    Practices that perform mammography are urged to review their Medicare claims dating back to October 1, 2017 to ensure proper payment. There was a system edit, causing the rejection of mammography claims using new, more specific ICD-10 codes. The edit has now been deactivated and these claims may be rebilled to Novitas for payment.

    In December 2017, a member alerted us to an issue in which Novitas (NJ’s Medicare contractor) was denying mammography claims using the most specific ICD-10 codes from the October 1, 2017 release. MSNJ asked Novitas for more information. We were advised that it was inappropriate to continue using unspecified ICD-10 code, N63, effective 9/30/17.  However, Novitas’ systems were not updated to accept the new specified codes and would not be able to do so until April 2, 2018.

    MSNJ further inquired with CMS and on December 20, 2017, CMS instructed the MACs, including Novitas, to deactivate the system edit causing the rejection of the new ICD-10 codes. Beginning April 2, 2018, the MACs will automatically adjust any claim denials resulting from the issue. In the meantime, practices may rebill these claims for payment now.

    On January 26, 2018, Novitas posted notice that a temporary correction was implemented. Again, claims denied for use of ICD-10 codes N63.11-N63.14, N63.21- N63.24, N63.31, N63.32, N63.41, N63.42, will be automatically adjusted for payment by Novitas beginning April 2, 2018. However, practices looking for payment sooner may rebill these claims to Novitas, now that the system edit has been deactivated. Please tell us how this issue has affected your practice.


    Released: February 1, 2018, 7:46 am
    Keywords: Announcements

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