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How to handle denied CRC claims from Medicare

This important update applies to all denied claims for colonoscopy following a positive stool-based test since Jan. 1.
Doctor writing notes in office
Doctor writing notes in office

Did Medicare return claims for a screening colonoscopy with the following dates and criteria?

Dates of service on or after January 1, 2023 marked as “return to provider” (Part A) and “return as unprocessable” (Part B), especially Part B claims with CARC 16: “Claim/service lacks information or has submission billing error(s)” and RARC N822: “Missing Procedure Modifier(s)” or RARC N823: “Incomplete/Invalid Procedure Modifier.”

Contact your Medicare Administrative Contractor (MAC) for guidance on claims reprocessing.

The agency shared this instruction as part of a new note in the update to its National Coverage Determination on Colorectal Coverage of Colorectal Cancer (CRC) Screening.

Don’t forget

Add the -KX modifier for Medicare screening colonoscopy claims for colonoscopy following a positive result from a non-invasive stool test.

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