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Family PACT Claims for Moderate Sedation Services May Erroneously Deny

October 9, 2017

An article published in the September 2017 Family Planning, Access, Care and Treatment (Family PACT) Update titled “2017 CPT-4/HCPCS Codes Annual Update for Family PACT” informed providers that, effective for dates of service on or after October 1, 2017, terminated moderate sedation services CPT-4 codes 99144 and 99145 are replaced with codes 99152 and 99153, respectively, as part of the 2017 update to Current Procedural Terminology – 4th Edition (CPT-4) codes.

For Family PACT, the system was not updated in time for the October 1, 2017, effective date. Claims for CPT-4 codes 99152 and 99153 submitted for dates of service starting October 1, 2017, may be denied.

An Erroneous Payment Correction (EPC) will be implemented to reprocess any erroneous denials for Family PACT claims submitted with dates of service between October 1, 2017, and implementation of the 2017 CPT-4/HCPCS annual update for Family PACT. Providers should continue to submit claims in a timely manner.