Novitas Claim Denials for 92014, 92134, and 67028 Will Be Mass Adjusted

March 14 update: As we reported last week (see below), Novitas will mass adjust these denials and they have already started to reprocess them. However, they are only adjusting the claims, Novitas is not refiling the claims so there is no crossover filing to secondary payors. You must refile all the secondary claims yourself unless Novitas soon changes its method.  

 

On February 25, 2022, the following notice was posted to the Novitas Medicare news and updates web page:

 "Incorrect denials for medical necessity 

An issue was identified with claims incorrectly denying for diagnosis requirements per LCD, Cardiology non-emergent outpatient stress testing (L35083). This issue impacted claims received between February 17 and February 23 with a date of service on or after January 1. All impacted claims will be identified and adjusted.”

On February 28, 2022, the following notice was posted:

Claims issues log

The claims issues log has been updated regarding claims incorrectly denying for diagnosis requirement per LCD, Cardiology non-emergent outpatient stress testing (L35083).” 

If you click on the Claims Issues Log, it states the following Description/Claim coding impact on February 28, 2022:

“An issue was identified with claims incorrectly denying for diagnosis requirements per LCD, Cardiology non-emergent outpatient stress testing (L35083). This issue would have impacted claims received for procedure codes 78456 to 99999 if they were not billed with a GA modifier. Denials occurred between February 17, 2022, thru February 23, 2022, and with a date of service on, or after January 1, 2022.”

CPT codes 92014 and 92134 fall within the affected procedure code range of 78456 to 99999. The Claims Issues Log also states that all impacted claims will be mass adjusted. Therefore, we are working on adjusting all affected claims that incorrectly denied. However, if providers do not want to wait for their claims to be adjusted, they may resubmit their claims. 

If a provider had denials for CPT code 67028, the provider may request a claim redetermination (appeal).  CPT code 67028 is not within the procedure code range that were denied incorrectly. However, if CPT code 67028 was reported on a claim along with any CPT codes that fall within the 78456 to 99999 procedure code range and the claim denied, again, those claims will be mass adjusted by Novitas, or providers can resubmit their claims if they prefer.