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Pricing has been updated for codes 93241, 93243, 93245, and 93247.
This edition includes information on hospital price transparency, Part B blood clotting factor furnishing fee guidance, Part B average sales price guidance, and more.
The Comprehensive Error Rate Testing (CERT) review contractor conducts a medical review of randomly sampled post-payment claims. If the claim was billed and paid correctly, the CERT review contractor will issue a “No Error” finding.
This procedure or procedure/modifier combination is not compatible with another procedure or procedure /modifier combination provided on the same day according to the National Correct Coding Initiative.
These checklists are intended to provide healthcare providers with a reference for use when responding to CERT documentation requests for the selected claim sample.
Avoid the appeals process by making minor claim corrections through a clerical reopening request for Part B claims.
Use the links on the left to access checklists to ensure you have met medical documentation requirements based on specific services.
View this article for information regarding local contractor pricing.
The help guide for the NCCI PTP lookup is currently being developed. Please check back soon.
Read the Part A second quarter edition of the CERT Insider's Guide to learn more about claim errors assessed during the CERT review process and ways to mitigate these errors in the future.