Production Alert Details
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Processing Issue Botulinum Toxin Claims Returned to Provider with 5PRIA

Date Reported:
10/22/2021
Date Updated:
03/02/2023
Date Resolved:
02/22/2023
Status:
Closed
Provider Types Impacted:

Jurisdiction 6 and Jurisdiction K Part A Providers

Reason Code(s):
5PRIA
Claim Coding Impact:
*Codes may be viewed in Billing and Coding: Botulinum Toxins (A52848).
Description of Issue

Part A claims that have been submitted with Botulinum J codes (J0585, J0586, J0587, J0588) have incorrectly RTP with reason code 5PRIA.

National Government Services Action

National Government Services updated 5PRIA on 2/22/2023. 5PRIA is currently active to capture claims submitted with Botulinum Toxin J codes (J0585, J0586, J0587, J0588) without a paired administration code.

Provider Action

Please resubmit claims that have incorrectly RTP with reason code 5PRIA with a new DCN with the appropriate J code and administration code. It’s important that providers do not resubmit with the original DCN in order for the claim to bypass the 5PRIA event prior to the changes made on 2/22/2023.

*Codes may be viewed in Billing and Coding: Botulinum Toxins (A52848).

Proposed Resolution/Fix

5PRIA is currently active to capture claims submitted with Botulinum Toxin J codes (J0585, J0586, J0587, J0588) without a paired administration code.

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