tci Part B Insider - 2013 Issue 35

Physician Note: This MAC Plans to Audit Level 5 Codes

If your physician’s go-to codes are 99205 and 99215, look for a lot more scrutiny of your claims going forward. At least that’s the word from one Part B MAC, which plans to start prospectively auditing these claims. “The National Government Services Medical Review Department will be conducting service-specific prepayment reviews of CPT® codes 99205 and 99215 for claims submitted to Jurisdiction 6 Part B for the states of Illinois, Minnesota, and Wisconsin,” NGS Medicare said in an Oct. 1 announcement. “If one of your claims is selected for review, you will receive an...

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