A Medicare contractor is expanding the range of place of service (POS) codes they'll accept on advance care planning codes -- and will "adjust" denials made on those grounds.
NGS (National Governments Services) announced in an email and posted here that claims on advance care planning codes 99497 and 99498 that had been denied only for POS would in some cases be paid. NGS is Medicare Part B administrative contractor (MAC) for Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Wisconsin.
These codes, which were made valid for Medicare starting Jan. 1 by the 2016 physician fee schedule, were kicked out by a "claims processing issue" that only recognized the office (11) and independent clinic (49) POS codes, NGS reported. CMS has not issued POS restrictions on the code.
NGS says it has now updated its system to accept claims on the service with POS of 04 (homeless shelter), 11 (office), 12 (home), 13 (assisted living facility, 14 (group home), 19 (off campus-outpatient hospital), 20 (urgent care facility), 21 (inpatient, hospital), 22 (on campus-outpatient hospital), 23 (emergency room - hospital), 31 (skilled nrusing facility), 32 (nursing facility), 33 (custodial care facility), 34 (hospice), 49 (independent clinic), 51 (inpatient psychiatric), 52 (psychiatric facility - partial hospitalization), 53 (community mental health center), 54 (intermediate care facility/ individuals with intellectual disabilities) 55 (residential substance abuse treatment center),57 (non-residential substance abuse treatment facility),61 (comprehensive inpatient rehabilitation facility), 62 (comprehensive inpatient rehabilitation facility), 65 (end-stage renal disease treatment facility) and 71 (public health clinic).
NGS also says "mass adjustments will begin immediately to claims that denied in error" and no provider action is needed.
No other Medicare contractors have issued a similar statement.