Claims Denied Incorrectly for NCD 90.2 Next Generation Sequencing

Claim Coding Impact: 0242U, 0239U, 0037U

Description of Issue: Noridian determined additional diagnosis codes are allowed per NCD 90.2, Next Generation Sequencing, based on the instruction in CMS Change Request 12124, “International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)–July 2021.” Therefore, Noridian will make system updates to allow additional diagnosis codes with procedure codes 0242U, 0239U and 0037U. The change is for dates of service on or after 07/01/21.

Noridian Action Required: Noridian will update the system.

Provider/Supplier Action Required: No action required.

Proposed Resolution/Solution: Noridian will mass adjust claims.
02/03/22 – The system was updated on 01/27/22. Noridian has started initiating adjustments.

Date Reported: 01/25/22