Palmetto GBA announced it will hold Medicare claims for certain colorectal cancer screening tests, including screening colonoscopy, FIT and Cologuard, until April.
This follows a similar announcement by Novitas Solutions to also hold CRC screening claims until April.
The temporary hold could end up impacting Medicare CRC screening claims nationwide. Palmetto says Medicare must update its claim processing system to accommodate 2023 colorectal cancer screening coverage changes, which is the reason claims must be temporarily held. Similar announcements from other Medicare Administrative Carriers (MACs) may follow.
Here’s what you need to know:
What providers are impacted?
The payment delay will impact providers in Palmetto Jurisdiction J (AL, GA, TN) and will only apply to Medicare claims.
What codes are affected?
G0104, G0105, G0106, G0120, G0121, G0327, G0328, 81528 and 82270 with dates of service on or after January 1, until April.
When will payments be released?
Payments made on April 4, 2023, or sooner if CMS directs the Medicare Administrative Contractors to do so.