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Erroneously Denied Ultrasound Claims

January 14, 2016

The Department of Health Care Services (DHCS) has identified a claims processing issue causing claims billed for the following CPT-4 codes with ICD-10-CM diagnosis code Z36 (encounter for antenatal screening of mother) to erroneously deny:

CPT-4
Code Description
76813 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal approach or transvaginal approach; single or first gestation
76814 each additional gestation

This issue affected claims for dates of service on or after October 1, 2015. Providers should continue to submit claims in a timely manner. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC).