An internal system processing
issue has caused some surgical procedure codes billed with modifier 22 processed on/after January 1, 2014, to
not allow any additional money above the fee schedule. First Coast Service
Options (First Coast) is currently identifying the impacted claims and will
begin to initiate adjustment action on all impacted claims within the next two
weeks. Note: only claims
previously reviewed by our medical staff having met medical necessity
requirements to allow above the fee schedule will be adjusted. Providers are
asked not to file appeals or call the First Coast call center regarding this
internal issue. First Coast apologizes for any inconvenience this issue has
caused.
Issue
An internal system
processing issue has caused some surgical procedure codes billed with
modifier 22 processed
on/after January 1, 2014, to not allow any additional money above the fee
schedule.
Resolution
First Coast is
currently identifying the impacted claims and will begin to initiate
adjustments on all impacted claims within the next two weeks. Claims having met
medical necessity requirements will be changed to an unlisted surgical
procedure code (modifier 22 will be appended to the related unlisted surgical
procedure) to allow payment above the Medicare physician fee schedule. First
Coast began utilizing this process July 11, 2014, for all surgical procedure
billed with the 22 modifier that
met medical necessity requirements for additional payment.
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