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Erroneous Denial of LEA Preventative Medicine Counseling Claims

March 23, 2016

A claims processing issue has caused Local Educational Agency (LEA) claims to erroneously deny when billed with CPT-4 code 99401 (preventative medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure], approximately 15 minutes) for more than one unit per day. This error is being corrected in the system. The maximum units for CPT-4 code 99401 will be restored to four units per day.

Affected claims will be reprocessed via an Erroneous Payment Correction (EPC) for dates of service on or after January 1, 2015. No action is required of providers.