decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 9 (September)
Modifier -26 to be paid on SNF PET scans
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Article Overview
This short Medicare coding update covers a CMS fix to claims edits that had been denying separate professional-component payment for certain PET scan services when billed in connection with a Part A skilled nursing facility stay. It is relevant to billing staff, coders, and revenue cycle teams who work with Medicare claims, CWF edits, and retroactive payment adjustments. The article also references a CMS transmittal and the effective/retroactive timing of the change.
Why This Topic Matters
It alerts Medicare billers to a payment-edit correction that may affect claims already submitted and indicates that previously processed claims may need follow-up for adjustment.
What You Will Learn
- What type of Medicare claims issue the article addresses
- Which general service category is affected
- How the timing of the CMS correction is described
- What follow-up may be needed for claims already processed
Who Should Read This
- Medical coders
- Hospital and facility billing staff
- Medicare claims processors
- Revenue cycle management professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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