Provider Specialty Edits for IBT for CVD on Professional Claims (Rev. 2432, 11-08-11)

by  Jared Staheli
July 6th, 2015

Contractors shall pay claims for HCPCS code G0446 only when services are submitted by the following provider specialty types found on the provider’s enrollment record:

01= General Practice

08 = Family Practice

11= Internal Medicine

16 = Obstetrics/Gynecology

37= Pediatric Medicine

38 = Geriatric Medicine

42= Certified Nurse Midwife

50 = Nurse Practitioner

89 = Certified Clinical Nurse Specialist

97= Physician Assistant

Contractors shall deny claim lines for HCPCS code G0446 performed by any other provider specialty type other than those listed above.

The following messages shall be used when Medicare contractors deny IBT for CVD claims billed with invalid provider specialty types:

CARC 185: “The rendering provider is not eligible to perform the service billed.” NOTE: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

RARC N95: “This provider type/provider specialty may not bill this service.”

MSN 21.18: “This item or service is not covered when performed or ordered by this provider.”

Spanish version: “Este servicio no esta cubierto cuando es ordenado o rendido por este proveedor.”

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:

Provider Specialty Edits for IBT for CVD on Professional Claims (Rev. 2432, 11-08-11). (2015, July 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/provider-specialty-edits-for-ibt-for-cvd-on-professional-claims-rev-2432-11-08-11-27052.html

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