• In recent months there has been an increase in this RUC code due to e-Prescribing codes being submitted incorrectly. See the e-Prescribing (eRx) incentive code FAQ to verify which eRx code you should be submitting.

• Data indicates that Current Procedural Terminology (CPT) code 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) is being submitted by providers. Based on Change Request (CR) 7234, effective for claims with dates of service on or after January 1, 2011, this CPT code will no longer be payable by Medicare. The Centers for Medicare & Medicaid Services (CMS) has created specific Healthcare Common Procedure Coding System (HCPCS) codes and payment allowances to replace CPT code 90658 for Medicare billing purposes for the 2010-2011 influenza season. Click here to read Medicare Learning Network® (MLN) Matters article 7234 that addresses this change and lists the corresponding HCPCS codes.

• Before submitting your claim, ensure you use the most current year's CPT codes.

• Verify the procedure codes being billed are payable and allowed under the Medicare program for the date of service being billed.

• Submit separate claims for services in different years of service. A procedure code valid in one year may not be valid in the other and will cause the entire claim to reject or deny.

• The CMS provides quarterly updates to some procedure codes. Although the codes may be valid, they may not be valid for the dates of service you are billing.

• The FCSO Medicare provider website has links addressing local medical coverage. Specific codes and data may be found within the local medical coverage Active/Future/Retired LCDs for indications and limitations of coverage or medical necessity.