The latest count, based on ongoing Part B News analysis, shows that the claims-processing errors are holding up claims in at least 32 states. Common services tangled up in the unintential claims errors include mammography services (G0204, G0206) and a range of injection codes.
Some notable errors include:
- Providers in 13 states — Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming — have seen delays on mammography codes G0204 and G0206, which are associated with approximately $75 million in reimbursement nationally, according to the latest available Medicare claims data from 2014.
- Practices in Florida, Puerto Rico and the U.S. Virgin Islands are coping with delays to claims involving injection code J0811 (Injection, darbepoetin alfa, 1 microgram [non-ESRD use]), which was billed 52 million times nationally, per 2014 claims data.
- Ten states — Connecticut, Illinois, New York, Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin — are dealing with hold-ups to several common injection codes, including high-volume pneumococcal vaccine codes 90670 and 90732, which saw national payment of more than $200 million in 2014.