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Claims Processing Issue for Screening and Diagnostic Mammography Codes

April 24, 2018

The Department of Health Care Services (DHCS) identified a claims processing issue for dates of service from October 1, 2017, through December 31, 2017, affecting CPT-4 codes 77065 (diagnostic mammography, including computer-aided detection when performed; unilateral), 77066 (…bilateral) and 77067 (screening mammography, bilateral, including computer-aided detection when performed). Claims are being erroneously denied with Remittance Advice Details (RAD) code 0196: This procedure requires a modifier; modifier is not present or 9702: This procedure code is not payable without an invoice.

An Erroneous Payment Correction (EPC) will be issued to reprocess affected claims. Impacted providers should continue to resubmit or appeal denied claims with proper documentation for timely processing. Providers may also check for updates regarding this issue on the Medi-Cal website.