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Erroneously Denied Antenatal Screening Claims

November 30, 2015

The Department of Health Care Services (DHCS) has identified and corrected an issue causing claims billed with CPT-4 code 76805 (ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester [> or = 14 weeks, 0 days], transabdominal approach; single or first gestation) and ICD-10-CM code Z36 (encounter for antenatal screening of mother) to erroneously deny.

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).