HCPCS 90658 Claim Hold
Part A providers in JK and J6.
Description of Issue
Claim hold for CPT 90658 (influenza vaccine)
National Government Services Action
NGS will hold claims and adjustments with HCPCS 90658 until the January 2025 release is implemented.
Claims and adjustments containing HCPCS 90658 will be suspended by NGS with reason code WW095 until the implementation of the January 2025 release.
Furthermore, ESRD monthly claims suspended with WW095 will be RTP'd with RC 7A000, accompanied by instructions to separate HCPCS 90658 and its administration code and submit them as stand-alone claims. These ESRD stand-alone claims and adjustments will be held until the January release is implemented.
When suspended claims are released in January 2025, NGS will append CC 15 to the claims.
Provider Action
Action is only indicated for the ESRD monthly claims described above. For the remainder of the claims, no other provider action is needed.
Proposed Resolution/Fix
January 2025