Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2824 Date: November 22, 2013

Transcription

1 anual ystem Pub edicare laims Processing Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 2824 Date: November 22, 2013 hange equest 8473 UBJET: New nfluenza Virus Vaccine ode. UY OF NGE: This hange equest () provides instructions for payment and WF edits to be updated to include influenza virus vaccine code for claims with of service on or after January 1, 2014, processed on or after pril 7, This also removes vaccine code 90658, vaccine administration codes G9141 and G9142, and temporary vaccine codes Q2034, Q2035, Q2036, Q2037, Q2038, and Q2039 from chapter 18 sections 1.2, , , , and n addition, this corrects the effective date of code Q2033 from 1/01/2013 to 7/01/2013. EFFETVE DTE: July 1, For code Q2033; January 1, For code PLEENTTON DTE: pril 7, 2014 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED /N/D PTE / ETON / UBETON / TTLE 18/1.2/Table of Preventive and creening ervices 18/10.2.1/ealthcare ommon Procedure oding ystem (P) and Diagnosis odes 18/10.4.1/WF Edits on F/B laims 18/10.4.2/WF Edits on arrier/b laims 18/10.4.3/WF /B rossover Edits for F/B and arrier/b laims. FUNDNG: For Fiscal ntermediaries (Fs), egional ome ealth ntermediaries (s) and/or arriers: No additional funding will be provided by ; ontractors activities are to be carried out with their operating budgets

2 For edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the statement of Work. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTENT: Business equirements anual nstruction *Unless otherwise specified, the effective date is the date of service.

3 ttachment - Business equirements Pub Transmittal: 2824 Date: November 22, 2013 hange equest: 8473 UBJET: New nfluenza Virus Vaccine ode EFFETVE DTE: July 1, For code Q2033; January 1, For code PLEENTTON DTE: pril 7, GENEL NFOTON. Background: This provides instruction for payment and WF edits to be updated to include influenza virus vaccine code for claims with dates of service on or after January 1, 2014, processed on or after pril 1, This also removes vaccine code 90658, vaccine administration codes G9141 and G9142, and temporary vaccine codes Q2034, Q2035, Q2036, Q2037, Q2038, and Q2039 from chapter 18 sections 1.2, , , , and n addition, this corrects the effective date of code Q2033 from 1/01/2013 to 7/01/2013. B. Policy: Effective for claims with dates of service on or after July 1, 2013, vaccine code Q2033 will be payable by edicare. Effective for claims with dates of service on or after January 1, 2014, vaccine code will be payable by edicare. nnual Part B deductible and coinsurance do not apply. ll physicians, non-physician practitioners and suppliers who administer the influenza virus vaccination must take assignment on the claim for the vaccine.. BUNE EQUEENT TBLE "hall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number equirement esponsibility /B ontractors shall change the effective date of influenza virus vaccine code Q2033 from 1/01/2013 to 7/01/2013. NOTE: This change is effective for claims with dates of service on or after 7/01/2013 processed on or after 10/07/2013. ontractors shall adjust claims processed on or after 10/07/2013 that are brought to their attention. B D E F E hared- ystem aintainers F V W F Other X X X OE ontractors shall update their systems to accept influenza virus vaccine code for dates of service on or after January 1, X X X X OE Effective for dates of service on and after January X

4 Number equirement esponsibility /B D E F 1, 2014, processed before pril 7, 2014, contractors shall use local pricing guidelines to determine payment rates for influenza virus vaccine code o-insurance and deductible do not apply. B E hared- ystem aintainers F V W F Other Effective for claims with dates of service on and after January 1, 2014, processed on and after pril 7, 2014, contractors shall use edicare Part B payment limit for influenza virus vaccine code according to TTP:// ng.html. o-insurance and deductible do not apply Effective for dates of service on and after January 1, 2014, contractors shall pay for vaccine code as follows: X X X X 1. ospitals (12X and 13X), NFs (22Xand 23X), (34X), hospital-based DFs (72X), and s (85X) based on reasonable cost. 2. ospitals (12X and 13X) and s (85X) based on the lower of the actual charge or 95% of the WP. 3. OFs (75X) and independent DFs (72X) based on the lower of actual charge or 95% of the WP. oinsurance and deductible do not apply ontractors shall add influenza virus vaccine code to existing influenza virus vaccine edits. X X Until systems changes are implemented, contractors shall hold institutional claims containing influenza virus vaccine codes with dates of service on or after January 1, 2014, X X

5 Number equirement esponsibility /B D E F received before pril 1, B E hared- ystem aintainers F V W F Other Once the system changes described in this instruction are implemented, contractors shall release the held claims, appending condition code 15. X X. POVDE EDUTON TBLE Number equirement esponsibility LN rticle: provider education article related to this instruction will be available at Education/edicare-Learning-Network- LN/LNattersrticles/ shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in the contractor s next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. /B B X X X D E F E X X Other

6 V. UPPOTNG NFOTON ection : ecommendations and supporting information associated with listed requirements: N/ "hould" denotes a recommendation. X-ef equirement Number ecommendations or other supporting information: ection B: ll other recommendations and supporting information: N/ V. ONTT Pre-mplementation ontact(s): William uiz, or william.ruiz@cms.hhs.gov, Joscelyn Lissone, or joscelyn.lissone@cms.hhs.gov Post-mplementation ontact(s): ontact your ontracting Officer's epresentative (O) or ontractor anager, as applicable. V. FUNDNG ection : For Fiscal ntermediaries (Fs), egional ome ealth ntermediaries (s), and/or arriers: No additional funding will be provided by ; ontractors activities are to be carried out with their operating budgets ection B: For edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. do not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

7 1.2 Table of Preventive and creening ervices (ev. 2824, ssued: , Effective: , for code Q2033; January 1, 2014-for code 90673, mplementation: ) ervice nitial Preventive Physical Examination, PPE Ultrasound creening for bdominal ortic neurysm () ardiovascular Disease PT/ P ode G0402 G0403 G0404 G0405 G0389 nitial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of edicare enrollment Electrocardiogram, routine EG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report Electrocardiogram, routine EG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination Electrocardiogram, routine EG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination Ultrasound, B-scan and /or real time with image documentation; for abdominal aortic aneurysm () ultrasound screening UPTF ating *Not ated B oins./ WVED Not Waived Not Waived Not Waived WVED Lipid panel WVED

8 ervice Diabetes creening Tests Diabetes elf- anagement Training ervices (DT) edical Nutrition Therapy (NT) ervices PT/ P ode holesterol, serum or whole blood, total Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol) UPTF ating oins./ WVED WVED Triglycerides WVED G0108 G Glucose; quantitative, blood (except reagent strip) Glucose; post glucose dose (includes glucose) Glucose; tolerance test (gtt), three specimens (includes glucose) Diabetes outpatient selfmanagement training services, individual, per 30 minutes Diabetes outpatient selfmanagement training services, group session (2 or more), per 30 minutes edical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes edical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes edical nutrition therapy; group (2 or more individual(s)), each 30 minutes B *Not ated *Not ated B WVED WVED WVED Not Waived Not Waived WVED WVED WVED

9 ervice PT/ P ode UPTF ating oins./ G0270 G0271 edical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes edical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes B WVED WVED creening Pap Test G0123 G0124 creening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision creening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician WVED WVED

10 ervice PT/ P ode UPTF ating oins./ G0141 creening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician WVED G0143 creening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision WVED G0144 creening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision WVED G0145 creening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision WVED G0147 creening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision WVED

11 ervice PT/ P ode UPTF ating oins./ G0148 creening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening WVED P3000 creening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision WVED P3001 creening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician WVED Q0091 creening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory WVED creening Pelvic Exam G0101 ervical or vaginal cancer screening; pelvic and clinical breast examination WVED creening ammography omputer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) B WVED

12 ervice PT/ P ode UPTF ating oins./ G0202 creening mammography, bilateral (2-view film study of each breast) creening mammography, producing direct digital image, bilateral, all views B WVED WVED G0130 ingle energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) WVED omputed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine) WVED Bone ass easurement omputed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine) B WVED WVED Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) WVED adiographic absorptiometry (e.g., photo densitometry, radiogrammetry), 1 or more sites WVED

13 ervice PT/ P ode UPTF ating oins./ Ultrasound bone density measurement and interpretation, peripheral site(s), any method WVED G0104 G0105 olorectal cancer screening; flexible sigmoidoscopy olorectal cancer screening; colonoscopy on individual at high risk WVED WVED olorectal ancer creening G0106 G0120 olorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema olorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema. *Not ated oins. pplies & Ded. is waived oins. pplies & Ded. is waived G0121 olorectal cancer screening; colonoscopy on individual not meeting criteria for high risk WVED Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive WVED G0328 olorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous WVED Prostate ancer creening G0102 G0103 Prostate cancer screening; digital rectal examination Prostate cancer screening; prostate specific antigen test (P) D Not Waived WVED

14 ervice PT/ P ode UPTF ating oins./ Glaucoma creening G0117 G0118 Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist Not Waived Not Waived nfluenza virus vaccine, inactivated, subunit, adjuvanted, for WVED nfluenza virus vaccine, split virus, preservative free, for intradermal use, for adults ages WVED nfluenza Virus Vaccine nfluenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for B WVED nfluenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for WVED nfluenza virus vaccine, split virus, when administered to children 6-35 months of age, for WVED nfluenza virus vaccine, live, for intranasal use WVED

15 ervice PT/ P ode UPTF ating oins./ nfluenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for WVED nfluenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for WVED nfluenza virus vaccine, live, quadrivalent, for intranasal use WVED nfluenza virus vaccine, trivalent, derived from recombinant DN (V3), hemagglutinin () protein only, preservative and antibiotic free, for WVED nfluenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for WVED nfluenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for WVED nfluenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for WVED

16 ervice PT/ P ode UPTF ating oins./ nfluenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for WVED G0008 dministration of influenza virus vaccine WVED Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for WVED Pneumococcal Vaccine Pneumococcal conjugate vaccine, 13 valent, for. Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or B WVED WVED G0009 dministration of pneumococcal vaccine WVED epatitis B vaccine, adult dosage (2 dose schedule), for WVED epatitis B Vaccine epatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for WVED epatitis B vaccine, adolescent (2 dose schedule), for WVED

17 ervice PT/ P ode UPTF ating oins./ epatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for WVED epatitis B vaccine, adult dosage, for intramuscular use WVED epatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for WVED G0010 dministration of hepatitis B vaccine WVED G0432 nfectious agent antigen detection by enzyme immunoassay (E) technique, qualitative or semi-qualitative, multiplestep method, V-1 or V-2, screening WVED V creening G0433 nfectious agent antigen detection by enzyme-linked immunosorbent assay (EL) technique, antibody, V-1 or V-2, screening WVED G0435 nfectious agent antigen detection by rapid antibody test of oral mucosa transudate, V-1 or V- 2, screening WVED moking essation G0436 moking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes WVED

18 ervice PT/ P ode UPTF ating oins./ G0437 moking and tobacco cessation counseling visit for the asymptomatic patient intensive, greater than 10 minutes WVED nnual Wellness Visit G0438 G0439 nnual wellness visit, including PPP, first visit nnual wellness visit, including PPP, subsequent visit *Not ated WVED WVED ealthcare ommon Procedure oding ystem (P) and Diagnosis odes (ev. 2824, ssued: , Effective: , for code Q2033; January 1, 2014-for code 90673, mplementation: ) Vaccines and their administration are reported using separate codes. The following codes are for reporting the vaccines only. P Definition nfluenza virus vaccine, inactivated, subunit, adjuvanted, for nfluenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18 64; nfluenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for ; nfluenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for ; nfluenza virus vaccine, split virus, for children 6-35 months of age, for ; nfluenza virus vaccine, live, for intranasal use; nfluenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for nfluenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for

19 P Definition Pneumococcal conjugate vaccine, 13 valent, for nfluenza virus vaccine, live, quadrivalent, for intranasal use nfluenza virus vaccine, trivalent, derived from recombinant DN (V3), hemagglutinin () protein only, preservative and antibiotic free, for nfluenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use nfluenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for nfluenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for nfluenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or ; epatitis B vaccine, adult dosage (2 dose schedule), for epatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for ; epatitis B vaccine, adolescent (2 dose schedule), for intramuscular use; epatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for ; epatitis B vaccine, adult dosage, for ; and epatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for. The following codes are for reporting administration of the vaccines only. The administration of the vaccines is billed using: P G0008 G0009 Definition dministration of influenza virus vaccine; dministration of pneumococcal vaccine; and *G0010 dministration of hepatitis B vaccine.

20 *90471 mmunization administration. (For OPP hospitals billing for the hepatitis B vaccine administration) *90472 Each additional vaccine. (For OPP hospitals billing for the hepatitis B vaccine administration) * NOTE: For claims with dates of service prior to January 1, 2006, OPP and non- OPP hospitals report G0010 for hepatitis B vaccine administration. For claims with dates of service January 1, 2006 until December 31, 2010, OPP hospitals report or for hepatitis B vaccine administration as appropriate in place of G0010. Beginning January 1, 2011, providers should report G0010 for billing under the OPP rather than or to ensure correct waiver of coinsurance and deductible for the administration of hepatitis B vaccine. One of the following diagnosis codes must be reported as appropriate. f the sole purpose for the visit is to receive a vaccine or if a vaccine is the only service billed on a claim the applicable following diagnosis code may be used. Diagnosis ode Description V03.82 Pneumococcus V04.81** nfluenza V06.6*** Pneumococcus and nfluenza V05.3 epatitis B **Effective for influenza virus claims with dates of service October 1, 2003 and later. ***Effective October 1, 2006, providers may report diagnosis code V06.6 on claims for pneumococcus and/or influenza virus vaccines when the purpose of the visit was to receive both vaccines. f a diagnosis code for pneumococcus, hepatitis B, or influenza virus vaccination is not reported on a claim, contractors may not enter the diagnosis on the claim. ontractors must follow current resolution processes for claims with missing diagnosis codes. f the diagnosis code and the narrative description are correct, but the P code is incorrect, the carrier or intermediary may correct the P code and pay the claim. For example, if the reported diagnosis code is V04.81 and the narrative description (if annotated on the claim) says "flu shot" but the P code is incorrect, contractors may change the P code and pay for the flu vaccine. Effective October 1, 2006, carriers/b s should follow the instructions in Pub , hapter 1, ection (arrier Data Element equirements) for claims submitted without a P code. laims for hepatitis B vaccinations must report the.d. Number of the referring physician. n addition, if a doctor of medicine or osteopathy does not order the influenza virus vaccine, the intermediary claims require:

21 UPN code LF000 to be reported on claims submitted prior to ay 23, 2008, when edicare began accepting NPs, only The provider s own NP to be reported in the NP field for the attending physician on claims submitted on or after ay 23, 2008, when NP requirements were implemented WF Edits on F/B laims (ev. 2824, ssued: , Effective: , for code Q2033; January 1, 2014-for code 90673, mplementation: ) n order to prevent duplicate payment by the same F/B, WF edits by line item on the F/B number, the beneficiary ealth nsurance laim () number, and the date of service, the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or and the pneumococcal procedure codes 90669, 90670, or 90732, and the administration codes G0008 or G0009. f WF receives a claim with either P codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or and it already has on record a claim with the same number, same F/B number, same date of service, and any one of those P codes, the second claim submitted to WF rejects. f WF receives a claim with P codes 90669, 90670, or and it already has on record a claim with the same number, same F/B number, same date of service, and the same P code, the second claim submitted to WF rejects when all four items match. f WF receives a claim with P administration codes G0008 or G0009 and it already has on record a claim with the same number, same F/B number, same date of service, and same procedure code, WF rejects the second claim submitted when all four items match. WF returns to the F/B a reject code 7262 for this edit. Fs/B s must deny the second claim and use the same messages they currently use for the denial of duplicate claims WF Edits on arrier/b laims (ev. 2824, ssued: , Effective: , for code Q2033; January 1, 2014-for code 90673, mplementation: ) n order to prevent duplicate payment by the same carrier/b, WF will edit by line item on the carrier/b number, the number, the date of service, the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688; the pneumococcal procedure codes 90669, 90670, or 90732; and the administration code G0008 or G0009.

22 f WF receives a claim with either P codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or and it already has on record a claim with the same number, same carrier/b number, same date of service, and any one of those P codes, the second claim submitted to WF will reject. f WF receives a claim with P codes 90669, 90670, or and it already has on record a claim with the same number, same carrier/b number, same date of service, and the same P code, the second claim submitted to WF will reject when all four items match. f WF receives a claim with P administration codes G0008 or G0009 and it already has on record a claim with the same number, same carrier/b number, same date of service, and same procedure code, WF will reject the second claim submitted. WF will return to the carrier/b a specific reject code for this edit. arriers/b s must deny the second claim and use the same messages they currently use for the denial of duplicate claims. n order to prevent duplicate payment by the centralized billing contractor and local carrier/b, WF will edit by line item for carrier number, same number, same date of service, the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688; the pneumococcal procedure codes 90669, 90670, or 90732; and the administration code G0008 or G0009. f WF receives a claim with either P codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or and it already has on record a claim with a different carrier/b number, but same number, same date of service, and any one of those same P codes, the second claim submitted to WF will reject. f WF receives a claim with P codes 90669, 90670, or and it already has on record a claim with the same number, different carrier/b number, same date of service, and the same P code, the second claim submitted to WF will reject. f WF receives a claim with P administration codes G0008 or G0009 and it already has on record a claim with a different carrier/b number, but the same number, same date of service, and same procedure code, WF will reject the second claim submitted.

23 WF will return a specific reject code for this edit. arriers/b s must deny the second claim. For the second edit, the reject code should automatically trigger the following edicare ummary Notice (N) and emittance dvice () messages. N: 7.2 This is a duplicate of a claim processed by another contractor. You should receive a edicare ummary Notice from them. laim adjustment reason code 18 duplicate claim or service WF /B rossover Edits for F/B and arrier/b laims (ev. 2824, ssued: , Effective: , for code Q2033; January 1, 2014-for code 90673, mplementation: ) When WF receives a claim from the carrier/b, it will review Part B outpatient claims history to verify that a duplicate claim has not already been posted. WF will edit on the beneficiary number; the date of service; the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688; the pneumococcal procedure codes 90669, 90670, or 90732; and the administration code G0008 or G0009. WF will return a specific reject code for this edit. ontractors must deny the second claim and use the same messages they currently use for the denial of duplicate claims.