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Family PACT Claims for CPT-4 Code 87624 Erroneously Denied

August 3, 2018

The Department of Health Care Services identified a claims processing issue causing Family Planning, Access, Care and Treatment (Family PACT) Program claims for CPT-4 code 87624 (infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], high-risk types [eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68]) billed with ICD-10-CM diagnosis codes Z01.42 (encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear) or Z87.410 (personal history of cervical dysplasia) to erroneously deny with Remittance Advice Detail code 9516: The secondary diagnosis code is missing or invalid for the procedure code.

An Erroneous Payment Correction will be issued to reprocess affected claims retroactive to August 1, 2016. No action is required of providers. Providers should continue to submit claims in a timely manner.