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Resubmission of Denied Medicare Non-Covered Incontinence Supplies Claims

December 29, 2017

The Department of Health Care Services (DHCS) identified a claims processing issue affecting medical supplies claims billed with incontinence wash HCPCS code A4335 (incontinence supply; miscellaneous) and incontinence cream/ointment HCPCS code A6250 (skin sealants, protectants, moisturizers, ointments, any type, any size).

Providers may resubmit claims that meet all of the following criteria:

  • Claims for dual-eligible beneficiaries that were denied with Remittance Advice Details (RAD) code 0012: Medi-Cal benefits cannot be paid without proof of payment/description of the denial from Medicare and that were for supplies dispensed for a Medicare non-covered treatment
  • Claims containing either HCPCS code A4335 or A6250
  • Claims denied on or after November 21, 2016

Providers may resubmit claims adhering to the criteria above through June 28, 2018.

Updated manual pages will be released in a future Medi-Cal Update.