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Provider Notification of Reprocessing of Diagnostic & Screening Mammography Services Rendered October 1, 2004 through March 31, 2005

In November 2006 the Centers for Medicare & Medicaid Services (CMS) issued Joint Signature Memorandum 07067 advising hospitals to change the Type of Bill (TOB) for diagnostic and screening mammography services from 14X to 13X and resubmit claims dated October 1, 2004 through March 31, 2005 for processing. Information within JSM 06067 indicated that the Fiscal Intermediary Standard System (FISS) would be modified in June 2007. The new logic was supposed to allow processing of screening/diagnostic mammography claims billed on a 131 TOB (instead of 141) for DOS October 1, 2004 thru March 31, 2005.

Prior to April 1, 2005, mammography claims were billed utilizing TOB 14X. Change Request (CR) 3469, issued October 29, 2004 instructed fiscal intermediaries (FI) to no longer allow these services to be billed under 14X TOBs effective for claims with dates of service on or after April 1, 2005. CR 3835, issued October 28, 2005 redefined the 14X TOB to apply only to nonpatient laboratory specimens effective for claims with dates of service on or after October 1, 2004.

Due to the implementation of changes issued in these CRs, providers have been unable to get diagnostic and/or screening mammography services processed to issue payment for the timeframe of October 1, 2004 through March 31, 2005. Claims submitted previously would have edited with reason codes 34924 or E51#7.

National Government Services, Inc. will accept diagnostic and screening mammography claims for the affected time period if submitted on a 141 TOB within the dates of February 2, 2008 through April 30, 2008. Providers are instructed to input “Refile of mammography DOS 100104-033105” in the remarks field (FL80) of these claims. Timeliness edits will be bypassed reflecting that this issue was not due to provider error, but due to system issues not allowing these claims to process properly.

Posted: 12/13/2007
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