Tips to prevent RUC CO 181

This RUC is assigned when the CPT or HCPCS code billed on the claim was invalid or not active for Medicare on the date(s) of service (DOS). While a CPT or HCPCS code may currently be valid, it may not be valid for the DOS on your claim.

• CPT codes are revised annually by the American Medical Association, with changes effective January 1. Make sure you are using a valid CPT book for the DOS on your claim.
• HCPCS codes are updated quarterly (beginning in January) by CMS. Review quarterly updates at CMS HCPCS quarterly updates.
• Verify the procedure code is valid / active and payable by Medicare for the DOS on the claim. Review code status via the Medicare Physician Fee Schedule Lookup Tool.
• To ensure claims are submitted with valid procedure codes, consider PC-ACE software, offered by First Coast, and updated with the most current CPT codes. For more information, refer to PC-ACE software.
• Submit separate claims for services in different years of service. A procedure code may be valid one year and not valid the following year.

To avoid delay in payment, submit a corrected claim with a valid CPT or HCPCS code. Claims rejected as unprocessable cannot be appealed, as an initial determination was not made. Refer to the article What you should do with claims returned as unprocessable for additional information.