Last Modified: 10/4/2022
Location: FL, PR, USVI
Business: Part B
National system issue inadvertently adjusted certain Part B claims
CMS identified a national system issue which may have inadvertently adjusted previously processed Part B claims with dates of service (DOS) on or after January 1, 2021. These adjustments processed on July 29 through August 2, 2022.
Impacted codes included the following: 99202-99205, 99211-99215, 99324-99328, 99334-99337, 99341-99345, 99347-99350, 99354-99355, 99495-99498, G0402, G0438, G0439, 99415, 99416.
Most of the claims that inadvertently adjusted did not result in a change in payment; therefore, most providers were not impacted and no actions are required. If the adjustment caused a payment change or denial and you disagree with the decision, please submit an appeal.
Claims for providers participating in the Primary Care First model are being reprocessed in some instances due to an error with a CMS Change Request for the Fee-For-Service claims processing system, which resulted in an incorrect payment. The reprocessing will ensure the provider receives the correct payment of a Flat Visit Fee rather than the Fee-For-Service fee for appropriate claims.
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