Some Medicare claims denied in error, to be reprocessed

Some preventive medicine, telephone and vision services for our Medicare members may have started to deny in error on July 1. These claims will be reprocessed in the coming weeks.

Why did this happen?

On July 1, CMS updated the medically unlikely edits (MUE) from one to zero for traditional Medicare plans for the following codes:

  • Preventive medicine services CPT codes 99381 – 99397 and 99401-99404

  •  Telephone services 98966-98979 and 94444

  • Vision services 92015

However, our Medicare plans continue to reimburse for these services at one unit per day.

 

Our system was updated accordingly but, some claims may have denied prior to identifying this change.  Services that have denied due to this change will be reprocessed in the upcoming weeks.

 

For additional information, see Medicare preventive services/ codes:  Procedures & services > Preventive care > Medicare preventive health services