Medi-Cal – Resubmission of Erroneously Denied Split Billable Services Claims

The Department of Health Care Services (DHCS) identified a claims processing issue affecting split billable services claims billed with CPT Procedure Codes 87070, 87075, 88280, 88271 and 88275 and National Correct Coding Initiative (NCCI) modifier. This issue caused some claims to erroneously deny with Remittance Advice Details (RAD) code 0196: This procedure requires a modifier; modifier Is not present. The issue affected claims for dates of service from October 15, 2015, through October 14, 2021.

No action is required on your part. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will resubmit the affected claims. These resubmissions will appear on RAD forms beginning December 9, 2021, with Claim Control Number (CCN) prefix 133655.

Source: https://files.medi-cal.ca.gov/pubsdoco/epc/2021/31519_p43325.pdf