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Correction: Radiology Claims Erroneously Denied with RAD Code 0090

September 11, 2018

A previous article published in the NewsFlash area of the Med-Cal website provided codes that were being erroneously denied. A correction to this announcement is as follows.

The Department of Health Care Services (DHCS) has identified a claims processing issue causing radiology services added under the 2018 CPT-4 Annual Update to be denied with Remittance Advice Details (RAD) Code 0090: The combination of procedure code and modifier is not valid on the dates of service billed. The issue affects claims for dates of service on or after February 1, 2018.

The following codes are affected when billed with modifier 26:

  • 70557 – 71010
  • 71021 – 71090
  • 74431 – 74471
  • 76828 – 76855

The following codes are affected when billed with modifier TC:

  • 72069
  • 72170
  • 72180
  • 72190
  • 72200
  • 76828 – 76856

For dates of service on or after October 1, 2012, CPT-4 codes 76820 and 77076 are affected when billed with modifier TC.

DHCS and the California MMIS Fiscal Intermediary are working to resolve this issue. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.