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Last Modified: 2/21/2018 Location: FL, PR, USVI Business: Part A, Part B

HETS application: IPPE HCPCS code changes and preventive HCPCS code financial changes

The Centers for Medicare & Medicaid Services (CMS) released several changes to the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS), which went into effect November 4, 2017. The changes impact providers who use First Coast Service Options’ (First Coast’s) Secure Provider Online Tool (SPOT) to access eligibility data through HETS.

IPPE HCPCS Code Changes

HETS 271 response may return Initial Preventive Physical Examination (IPPE) preventive HCPCS code information differently. The IPPE HCPCS codes (G0402, G0403, G0404, and G0405) are returned by HETS as supported preventive codes, with their next eligible dates set to the first day of the beneficiary’s initial Part B enrollment by CWF. IPPE services are only available within the Medicare beneficiary’s first 12 months of Medicare Part B eligibility.

Preventive HCPCS Code Financial Changes

HETS no longer returns preventive HCPCS code financial information for QMB periods when the beneficiary is dual-eligible for both Medicare and Medicaid for the entire year.
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