Fee Schedule Adjustments Reminder for 99441-99443
National Government Services has received several inquiries from providers regarding the adjustment of CPT codes 99441-99443. When CMS announced that they were changing the fee schedule allowance for these procedures to mirror codes 99212-99214, they also announced that MACs would be adjusting previously submitted claims to allow the codes billed at a higher allowance.
It is important to remember that NGS processes claims using the Medicare Part B Physician Fee Schedule. The allowance for related claims will be the lower of the published fee schedule rate and the submitted amount for that service. Therefore, if the submitted charge for codes 99441-99443 was lower than the fee schedule amount, the claim will not be allowed at the adjusted fee schedule. Services will never allow greater than the charge submitted by a provider.
If you have charges for codes 99441-99443 that were not adjusted to equal the new allowance indicated by CMS, please check the submitted amount for the service. If the submitted amount is not accurate and needs to be corrected, then you may do so via the reopening process.
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Posted 8/25/2020