Frequency Edits for IBT for CVD Claims (Rev. 2432, 11-08-11)

by  Jared Staheli
July 6th, 2015

Contractors shall allow claims for G0446 no more than once in a 12-month period.

NOTE: 11 full months must elapse following the month in which the last G0446 IBT for CVD took place.

Contractors shall deny claims IBT for CVD claims that exceed one (1) visit every 12 months.

Contractors shall allow one professional service and one facility fee claim for each visit.

The following messages shall be used when Medicare contractors deny IBT for CVD claims that exceed the frequency limit:

CARC 119: “Benefit maximum for this time period or occurrence has been reached.”

RARC N362: “The number of days or units of service exceeds our acceptable maximum.”

MSN 20.5: “These services cannot be paid because your benefits are exhausted at this time.”

Spanish Version: “Estos servicios no pueden ser pagados porque sus beneficios se han agotado.”

Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.

Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.

References:

Frequency Edits for IBT for CVD Claims (Rev. 2432, 11-08-11). (2015, July 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/frequency-edits-for-ibt-for-cvd-claims-rev-2432-11-08-11-27054.html

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