Cardiac and Pulmonary Rehab Place of Service (POS) 10 Denials - Resolved 09/26/24

Provider/Supplier Type(s) Impacted: All

Reason Codes: Not applicable

Claim Coding Impact: Not applicable

Description of Issue: There has been an issue identified where claim details that contain CPT 94625-94626, 93797-93798 and HCPCS G0422-G0423 are currently denying incorrectly when billed with Place of Service 10. This is due to conflicting editing that is in place for Telehealth Services and Cardiac/Pulmonary Rehabilitation policies that the Center for Medicare and Medicaid Services (CMS) instructed to be implemented. This impacts claims billed on/after 07/08/2024 for DOS 01/01/24 and after. Claims that are impacted will receive the following messaging: CARC 96, RARC N42 and MSN 21.25

Noridian Action: Noridian is in the process of correcting the issue.

Provider/Supplier Action Required: Please allow two weeks for the adjustments to process. Providers should review the adjusted claims on their Remittance Advice (RA) for the claims processing determination.

Proposed Resolution/Solution: Noridian will mass adjust the impacted claims.

09/13/24 - The shared system was updated on 08/22/24 to allow for CPT/HCPCS codes to process correctly with POS 10. Noridian will provide another update when the mass adjustments are initiated.

09/19/24 - Noridian initiated mass adjustments on 09/19/24.

09/26/24 – Noridian finished initiating mass adjustments on 09/25/24.

Date Reported: 07/18/24

Date Resolved: 09/26/24

Last Updated $dateUtil.getDate( $modifieddate , "MMM dd , yyyy" , $locale , $tzone )