IHCP to mass adjust UB-04 claims for CPT code 88142 that paid incorrectly

The Indiana Health Coverage Programs (IHCP) has identified a claims processing issue that affects certain claims billed for CPT code 88142 – Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision. UB-04 claims billed for CPT code 88142 for DOS on or after January 1, 2013, may have overpaid. This applies to fee-for-service (FFS) claims only. Pursuant to Section 1903(i)(7) of the Social Security Act, Medicaid reimbursement for individual clinical laboratory procedures cannot exceed the Medicare rate of reimbursement. CPT code 88142 should have paid at a maximum rate of $14.60 during the specified time frame, regardless of the claim type billed. The claims processing system has been corrected to reflect the appropriate rate. Affected claims will be mass adjusted. Providers should begin to see the adjusted claims on Remittance Advices (RAs) beginning September 22, 2015, with internal control numbers (ICNs) that begin with 56 (mass adjusted). If a claim was overpaid, the net difference appears as an accounts receivable. The accounts receivable will be recouped at 100% from future claims paid to the respective provider number.