Medicare Part B providers administer medically-necessary and preventive services for beneficiaries by diagnosing and treating medical conditions or preventing illness or detecting it at an early stage.
Posted Apr 20, 2021
Posted Apr 20, 2021
Posted Apr 19, 2021
Posted Apr 16, 2021
Posted Apr 16, 2021
NGS Medicare Physician Fee Schedule Fee Posting Error
10/28/20
Closed
Jurisdiction 6 and Jurisdiction K Part B providers
10/28/20
N/A
76496TC, 76497TC, 76498TC,78429, 78429TC,78430, 78430TC, 78431, 78431TC, 78432, 78432TC, 78433, 78433TC
Effective January 2020, these identified contractor-priced CPT codes were listed incorrectly on the NGS MPFS Full Fee Schedule. Search results for these codes incorrectly displayed OPPS fees.
Despite the incorrectly posted information, claims for these codes were not impacted and were processed and paid correctly. The incorrect fee information has been removed.
No provider action necessary at this time.
10/28/2020
NCD ICD-10 Diagnosis Code Changes for 2020
12/19/19
Closed
Part B
4/6/20
N/A
Multiple ICD-10 codes
On 11/1/2019, CMS issued CR11491 and accompanying MLN11491 with an effective date of 4/1/2020. CMS has now issued additional instructions impacting the following NCDs, for which new ICD-10 diagnosis codes will not be systematically implemented until 4/6/2020.
Local temporary editing is being developed for the following, allowing claims to process:
Editing will remain in place for the following and denied claims subject to the standard appeal process:
For NCDs 20.9, 20.34, 190.11 and 260.9, National Government Services (NGS) is in the process of modifying internal editing to allow processing for claims with the new ICD-10 diagnosis codes. For NCDs 110.4 and 210.3, denials relative new ICD-10 codes may be submitted as appeals.
Appeals are to be submitted in writing, not via NGSConnex. When submitting associated appeals, providers may identify CR11491 as a reference. Providers are advised to monitor the Production Alerts section of our website and future Email Updates for additional status information.
Systematically implemented 4/6/2020.
Some Accelerated Payments Showing Incorrect Positive Value
4/22/20
Closed
J6 and JK Providers
4/26/20
N/A
N/A
Some X12 835 ERA files are showing accelerated payments as positive values in the PLB segment (provider adjustment). The accelerated payments should be showing as a negative value which increases the payment to the provider in the remittance file only.
4/22/2020: Listserv was sent to J6 and JK provider community to alert them of positive accelerated payment amounts that are not impacting actual payments. National Government Services is actively working on a fix.
4/26/2020: NGS implemented a fix and the issue is now resolved. Accelerated payments will now show as a negative value on any X12 835 ERA files delivered 4/27/2020 and after.
No action is required. This issue has been resolved.
Implementation date: 4/26/2020
POS 22 Denials for 0298T
3/17/20
Closed
JK and J6 Part B Providers
3/24/20
N/A
0298T claim denials with place of service (POS) 22 (Message 921 per Edit 144D)
Claims for CPT 0298T with POS 22 were denied when received between 2/4/2020–3/11/2020 due to a temporary change in POS editing. CPT 0298T is now payable in POS 22.
Mass adjustments completed on 3/24/2020.
N/A
3/24/2020
Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.
10/22/19
Closed
Ambulance providers that bill to Part B of A
10/24/19
N/A
An error in Part A skilled nursing facility (SNF) consolidated billing (CB) edit logic is causing incorrect denials for Part B ambulance claims.
Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.
As per a CMS directive, NGS is manually bypassing the SNF CB edit for incoming Part B emergency ambulance transportation claim lines containing HCPCS code A0427, A0429, A0433, billed with or without A0425, when the beneficiary is in a SNF Part A covered stay.
Update 11/14/2019: Part B Providers who identify claims denied in error may request written reopening to have the claim reprocessed. Use the In
Writing instructions on the Appeals page of our website to ensure your request is processed accurately. Please continue to check the Production Alerts section of our website and future Email Updates for additional status information.
Implementation Date: 10/24/2019
