Abortion Procedure Code 88304

Since July 1, 2013, some abortion-related claims billed with procedure code 88304 (surgical pathology, gross and microscopic examination) have processed in error. Normally, these claims would pend for nurse review and be subject to a variety of edits. For example, all provider types submitting claims for reimbursement – including any associated services following an abortion – will be denied or recouped if the abortion statement on file is invalid or missing. The abortion-related claims billed with procedure code 88304 did not pend for nurse review. This issue has been resolved. A provider notification will be posted in a Medicaid Bulletin when claim reprocessing is required. For more information, providers should refer to Clinical Coverage Policy 1E-2, Therapeutic and Non-therapeutic Abortions, on DMA’s Obstetrics and Gynecology Clinical Coverage Policy web page.

Source: https://ncdma.s3.amazonaws.com/s3fs-public/documents/files/Medicaid_Bulletin_2017_07_0.pdf