Iowa

Medical Review has completed an article for the Widespread Service-Specific Probe for Hemoglobin A1C, CPT code 83036. Records were reviewed to determine whether the procedure code billed met all documentation requirements for the services billed. Services for CPT code 83036 were denied if the documentation did not support the service billed as defined in the NCD 190.21 - Glycated Hemoglobin/Glycated Protein.

The major issues identified that led to the denial of 70.00% of these services are as follows:

Providers are advised to use the modifier "GD" for all dates of service to indicate when services provided exceeds the maximum units allowed by Medicaid. The modifier is to be used whether the modified code is a CPT or HCPCS type. This policy is not prohibited under the National Correct Coding Initiative (NCCI).

Recently, WPS Medicare began seeing a dramatic increase in the number of providers experiencing claim denials when the provider submits claims past the timely filing limit for submitting claims. Although WPS Medicare recognizes that many providers must submit claims after Medicare's timely filing limit due to circumstances beyond their control, WPS Medicare must deny any claim submitted after the time limit for filing the claim expires.