decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 1 (January)
Radiology: Mammogram HCPCS codes must match facility certification
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Article Overview
This article covers a Medicare policy update affecting screening mammography claims, with emphasis on facility certification status, HCPCS billing categories, and the role of CMS Transmittal 1387. It is relevant to radiology billing staff, compliance teams, and providers who refer patients for mammography services. The discussion focuses on how claims handling changes when the billed mammography type does not align with the facility’s certification status.
Why This Topic Matters
It helps readers understand a billing-policy change that can affect claim acceptance, rework, and appeals for mammography services.
What You Will Learn
- How a Medicare policy update affects screening mammography claims
- Why facility certification status matters for mammography billing
- What types of claim handling are discussed in the policy change
- Which organizations and documents are associated with the update
Who Should Read This
- Radiology billing staff
- Medical coders
- Compliance teams
- Physicians ordering screening mammograms
- Facility administrators
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