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Novitas changes Co-management Claim Filing Instructions for Modifier -55

Novitas Solutions, Inc. (formerly known as Highmark Medicare Services) has begun asking for some slight changes to claims submitted for co-management of surgical services with modifier 55. Novitas is the Medicare Administrative Contractor (MAC) for a large number of areas in the eastern and central US. Non-compliant claims may be denied.

Novitas’ claims instructions for the surgeon’s -55 portion appear to be unchanged, but Novitas now appears to want an “exact date range” instead of an “assumed care” date for the receiving physician. Not all Novitas areas have a published policy, but the Pennsylvania LCD (link here) references an Article that notes the following:

“Where a transfer of postoperative care occurs, the receiving physician must report the date the surgery was performed in item 24A of the CMS-1500 claim form or the equivalent for electronic submissions. In addition, he/she must code the surgical code with modifier –55. Additionally, the exact dates for which he/she provided post-op care management must also be reported in item 19 of the CMS-1500 claim form or the electronic equivalent.”

Not all carriers want the same information, so be sure and check. Constant vigilance is needed in this rapidly changing landscape for claims, coding, and reimbursement. Corcoran Consulting Group prides itself on providing timely, accurate, and up-to-date information to our clients – contact us via phone during business hours or 24 hours via our website.

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