AthensCoder
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Hello All,
I work in an ASC facility in which we bill Humana Medicare on a UB_04 claim form and have for the duration of the 6 years I have been employed her. August our office started getting denials for invalid/missing revenue code for G0105 & G0121. In my research, I discovered the below changed effective 07/04/2024.
We do not reimburse charges for HCPCS codes G0104, G0105 or G0121 unless submitted with a bill type of 013X or
085X as well as one of the revenue codes listed below. The revenue codes listed are defined as: • 0360 – Operating
room services, general • 0361 – Operating room services, minor surgery • 0450 – Emergency room, general • 0510 –
Clinic, general • 0519 – Clinic, other • 0750 – Gastrointestinal services, general • 0761 – Specialty services treatment
room
The above limitations for colorectal screening services represented by HCPCS codes G0104, G0105 and G0121 are
established according to the CMS Medicare Claims Processing Manual and the UB editor
My delimma here is the billy type 013X is hospital & 085X is for cirtical access hospital Neither of these bill types would be appropriate for Ambulatory Surgery Center. For ASC it is bill type 0831 and revenue code 0490.
If you are in an ASC which claim form type are you billing Humana Medicare Advantage plans? Or can anyone shed some light on this?
Thank you,
Sonja
I work in an ASC facility in which we bill Humana Medicare on a UB_04 claim form and have for the duration of the 6 years I have been employed her. August our office started getting denials for invalid/missing revenue code for G0105 & G0121. In my research, I discovered the below changed effective 07/04/2024.
We do not reimburse charges for HCPCS codes G0104, G0105 or G0121 unless submitted with a bill type of 013X or
085X as well as one of the revenue codes listed below. The revenue codes listed are defined as: • 0360 – Operating
room services, general • 0361 – Operating room services, minor surgery • 0450 – Emergency room, general • 0510 –
Clinic, general • 0519 – Clinic, other • 0750 – Gastrointestinal services, general • 0761 – Specialty services treatment
room
The above limitations for colorectal screening services represented by HCPCS codes G0104, G0105 and G0121 are
established according to the CMS Medicare Claims Processing Manual and the UB editor
My delimma here is the billy type 013X is hospital & 085X is for cirtical access hospital Neither of these bill types would be appropriate for Ambulatory Surgery Center. For ASC it is bill type 0831 and revenue code 0490.
If you are in an ASC which claim form type are you billing Humana Medicare Advantage plans? Or can anyone shed some light on this?
Thank you,
Sonja