Erroneously Denied Ultrasound Claims
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:
|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).