Updated Medicare Payment Policies Effective 12/1/22022
Date: 10/24/22
Medicare claims for dates of service 12/1/2022 and after will follow the CMS National Coverage Determination (NCD) for the edits listed in the tables below. The denial code EXzS will be applied when the claim is billed with an invalid diagnosis, frequency, age, or modifier depending on the NCD Policy criteria. The edits will be applied to all claim types except for inpatient claims.
The table below includes the NCD, title, brief description, and a link to its location on the CMS National Coverage Database site.
The home page of the CMS National Coverage Database Search can be accessed here: https://www.cms.gov/medicare-coverage-database/search.aspx
NCD | Title/Topic | NCD Description | Link Once on the page, review Claim Processing Instructions |
150.3 | Bone Mineral Density Studies | Looks at procedure codes 0508T,0554T,0555T,0556T, 0557T, 0558T, 76977, 77078, 77080, 77081, 77085, G0130 to confirm correct diagnosis dictated by Medicare is billed | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=256&ncdver=2&bc=0 |
190.21 | Glycated Hemoglobin Glycated Protein | Looks at procedure codes 82985, 83036 to confirm correct diagnosis dictated by Medicare is billed | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=100&ncdver=1&bc=0 |
20.4 20.4Z | Implantable Cardiac Defibrillators | Looks at bill type, place of services, for procedure codes 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, & G0448 and takes into consideration diagnosis | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=110&ncdver=4&bc=0 |
210.10 210.10Y | Screening for Sexually Transmitted Infections (STIs) & High-Intensity Behavioral Counseling (HIBC) to Prevent STIs | Restricts Chlamydia (86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810), Gonorrhea (87590, 87591, 87850), Syphilis (86592, 86593), and Hep B (87340, 87341) screening for certain type of bills, diagnosis, place of services, and specialty | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=352&ncdver=1&bc=0 |
If you have questions, please contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.