Processing Claims with Non-covered Charges

In the past, when providers had both covered and non-covered charges for a given HCPCS or revenue code, they were required to split these into separate bills. Effective for bills with dates of service on and after April 1, 2002, when providers have an instance in which there are covered and non-covered units for services for a single HCPCS or revenue code, that could be submitted on a single line, split such submissions into two lines, one with all the covered charges and the other with all of the non-covered charges.

If units come in with non-covered charges put them on the non-covered line. If units come in with covered charges, put them in the covered charges line.

These instructions will become effective and will be implemented for claims with dates of service on and after January 1, 2003.

Program Memorandum A-02-071, CR 2154