Production Alert Details

Home Health Core-Based Statistical Area Payment issue (Code 50007)

Date Reported:
Date Resolved:
Provider Types Impacted:

Part A home health providers in Jurisdiction K and Jurisdiction 6

Reason Code(s):
Claim Coding Impact:
Core-Based Statistical Area (CBSA) Code 50007 in Value Code 61 field

Description of Issue

CBSA Code 50007 was loaded into the CY 2021 wage index table of the home health (HH) Pricer with an incorrect effective date. This error is causing incorrect payment on claims with CBSA 50007 in the Value Code 61 amount field by using the wrong wage index in payment calculation. National Government Services (NGS) has been instructed by the Centers for Medicare & Medicaid Services (CMS) to suspend claims with CBSA Code 50007 and to change it to CBSA Code 28020 which will utilize the correct wage index, allowing for accurate payment for these claims.

National Government Services Action

By 9/1/2021, HH claims with CBSA code 50007 will be suspended. NGS will change the CBSA code to 28020 in order to accurately calculate payment on these claims and release them for processing.

Provider Action

No provider action is indicated at this time, however, please continue to check for future Email Updates. Providers may continue to submit these claims in the usual manner.

Proposed Resolution/Fix

NGS will adjust any prior claims impacted by this error within 60 days by changing CBSA 50007 to CBSA 28020. Condition Code 15 may be appended when necessary to any claims affected by this process. Adjustments completed 10/13/2021