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Upcoming EPC for Intrauterine Contraceptive System Claim Denials

December 9, 2016

Reimbursement rates for HCPCS codes J7297 (levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 3 year duration) and J7298 (levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 5 year duration) are scheduled to implement the first quarter of 2017. An Erroneous Payment Correction (EPC) will be issued for claim denials under Remittance Advice Details (RAD) codes 9702: This procedure code is not payable without an invoice and 0188: This is a “By Report” procedure. No report is attached or the attached report is insufficient to warrant payment. The EPC will be effective for dates of service on or after October 1, 2016, to the implementation date of the reimbursement rates.

Pending the EPC’s release, providers may choose to resubmit denied claims under RAD codes 9702 and 0188 with appropriate attachments.