Medi-Cal to Reprocess 2 Years’ Worth of Improper Denials

Recently in California, the Department of Health Care Services (DHCS) has identified a claims processing issue on CPT 87255 (Virus Isolation) causing denials for non-payments when billed with ICD-10-CM Diagnosis codes Z30.46 (Encounter for Surveillance of Implantable Subdermal Contraceptive) and N76.6 (Ulceration of Vulva) amongst the Family Planning, Access, Care and Treatment (Family Pact) Programs. Additionally, CPT 87624 (Infectious Agent Detection by Nucleic Acid [DNA or RNA]); Human Papillomavirus (HPV), High Risk types when billed with ICD-10 CM Diagnosis code Z01.42 (Encounter for Cervical Smear to Confirm Findings of Recent Normal Smear following Initial Abnormal Smear) or Z87.410 (Personal History of Cervical Dysplasia) were denied incorrectly. According to DHCS, an Erroneous Payment Correction will be issued to reprocess claims retroactively to August 1, 2016.

APS will continue to monitor this and other payer issues that affect client revenue.  If you have additional questions, please contact your Practice Manager.