• Denials for CPT Codes 75572 – 75574

    CPT codes 75572-75574 have been opened for reimbursement effectivie 1/1/2010.  Claims billed with these codes which denied for Edit 0439 – PROCEDURE NOT A BENEFIT FOR DATE OF SERVICE will be reprocessed for dates of service 1/1/2010 – 8/11/2011.  The mass adjustments will begin the week of 02/13/2012.  If you have any questions, please contact…

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  • Vaccines for Children Update

    The Division of Medicaid (DOM) claims processing procedures were recently modified to be in compliance with the 2009 Code Update AMA change in regards to the billing rules for immunization codes 90471 and 90473.  The AMA ruling indicated only one or the other code can be billed on a single date of service.  The recent…

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  • Prior Authorization for Plastic Surgeons

    Office visits/consults (including follow-up after procedures) with plastic surgeons do not require prior authorization for par providers.  Surgery would still require prior authorization as with all other outpatient surgical procedures.

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