Fee Schedule Error Correction

As we reported at the end of January, there was an error in the 2017 Medicare Physician Fee Schedule file affecting payment for the interpretation of the second-eye biometry, 76519-26 or 92136-26. 

The 2017 Medicare Physician Fee Schedule published in January erroneously changed the bilateral indicator from a “3” to a “2” resulting in a denial for the second eye interpretation. 

Today, CMS released MedLearn Matters #9977, providing the April 2017 update to the MPFS database used by Medicare contractors to pay claims.  In the file, it corrects the bilateral indicator for 92136-26 and 76519-26 back to a “3”.

The change is retroactive to January 1, 2017, with an implementation date of April 3, 2017.  However, corrections will not be automatic.  The transmittal states:

Note that MACs need not search their files to either retract payment for claims already paid or to retroactively pay claims already processed. However, the MACs will adjust such claims that you bring to their attention. Make sure that your billing staffs are aware of these changes.

Billing staff will need to reprocess denied claims after April 3, 2017 for payment. 

The full document can be found at:  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9977.pdf

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