Make Sure These Medicare Missteps Didn’t Affect Your Claims
By Ellen Terry


Because of all of the policies, edits, determinations, rules, and revisions, Medicare’s claims processing sometimes goes awry for certain codes, fees, or other specific claim elements. The Centers for Medicare & Medicaid Services (CMS) reports these errors and their fixes on a regular basis. 

For the three errors below, you don’t have to do anything to make corrections – Novitas Solutions, the Medicare payer for Texas, will make them systemwide. But you might want to track the payment of any of your affected claims. 

  1. Effective Oct. 1, 2018, CMS established average sales price fees for two “not otherwise classified” drugs: Fasenra (benralizumab) and Cinvanti (aprepitant). However, some claims submitted for these two drugs that processed from Oct. 1 to Dec. 31 did not use the newly established fees. CMS reported this error March 14. Novitas will automatically adjust the affected claims. 
  1. On Jan. 1, local coverage determination (LCD) L35101 (Psychiatric Code) implemented the new Current Procedural Terminology (CPT) codes 96138, 96139, and 96146 as noncovered. But on Feb. 28, revisions to the LCD, effective Jan. 1, removed the noncovered status of these three codes and added them as covered codes to CPT Code Group 1 and ICD-10 Group 1 Paragraph. In some claims, CPT codes 96138, 96139, and 96146 were denied based on the noncovered policy decision. CMS reported this error March 4. Novitas will automatically reprocess these claims. 
  1. Due to a system edit, some claims for pathology services (CPT codes 88300, 88302, 88305, 88307, 88309, 88331, 88332, 88341, 88342, or 88344) were denied in error. CMS reported this error on Feb. 26. Novitas will automatically adjust the affected claims.

Last Updated On

April 16, 2019

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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