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CPT-4 Code 87255 Erroneously Denied for Family PACT Program

August 6, 2018

The Department of Health Care Services (DHCS) identified a claims processing issue causing Family Planning, Access, Care and Treatment (Family PACT) Program claims for CPT-4 code 87255 (virus isolation; including identification by non-immunologic method, other than by cyoptathic effect [eg, virus specific enzymatic activity]) billed with ICD-10-CM diagnosis codes Z30.46 (encounter for surveillance of implantable subdermal contraceptive) and N76.6 (ulceration of vulva) to erroneously deny with Remittance Advice Details (RAD) code 0169: This service is not payable when billed with this diagnosis.

An Erroneous Payment Correction (EPC) 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.