Update on CGS and Palmetto GBA Issues with Home Health Claims with Episodes Crossing January 1, 2016

Agencies should be aware that CGS has indicated all Home Health Claims submitted with episodes that cross the January 1, 2016 time point which may hold HCPCS codes G0154, G0299 and G0300 are being RTP’ed with an S status or suspended.  Manual review of claims is being conducted.  No further action will be required.  CGS will notify the provider of Claims determined to be in error through the usualy channels.

Palmetto GBA has indicated all claims submitted with episodes crossing the January 1, 2016 time point will be placed in RTP with reason code  32402 or 32403.  No agency action is required at this time.  Palmetto has indicated when the issue is resolved further instructions will be provided  through their Claims Payment Issues Log.

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