CMS corrects type-of-service snafu for screening mammography claims

If you've been unduly denied for screening mammography claims in the first few months of 2018, a technical glitch may have been the cause of your trouble, according to an April 13 update from CMS.

 

The root of the problem was an errant type of service (TOS) indicator that Medicare administrative contractors (MACs) were ascribing to CPT code 77067 (Screening mammography, bilateral [two-view study of each breast], including computer-aided detection). Instead of TOS code"1" (Medical care), it appears some MACs were processing the code with an indicator of "4" (Diagnostic radiology), which was leading to a disconnect between expected documentation from providers and the actual documentation they were submitting.

 

"Correcting the TOS code for 77067 allows the screening mammography claims to be billed without referring physician information on the claim, which is consistent with Medicare's coverage policy for screening mammograms," says CMS in MLN Matters MM10607.

 

Following a period of confusion and delays surrounding the series of CPT mammography codes that debuted in 2017, CMS had instructed providers to pivot from HCPCS code G0202 to 77067 on Jan. 1, 2018. The latest billing correction should smooth providers' claims reporting, and you won't have to go back and resubmit any claims affected by the TOS error.

 

"MACs will automatically reprocess previously adjudicated screening mammography claims received with CPT — 77067 with a TOS code of '4' with dates of service on and after January 1, 2018, and through July 2, 2018, when the claim was denied because there was no referring provider information," CMS says.

 

Also, MACs have until July 2 to implement the change across the board.

 

Don't forget that you can now report prolonged care codes (G0513-G0514) when you bill screening mammography services, and meet the requirements for the prolonged service codes.