Billing Tips: Family PACT (Planning, Access, Care and Treatment)

Remittance Advice Details (RAD) Claim Denials

RAD codes 0105 and 0115: This service requires a valid Family PACT Sterilization Consent Form. The Sterilization Consent Form is incomplete. A letter is being sent that indicates needed correction(s).

  • Verify the correct consent form is being used.
  • Effective February 1, 2006, Family PACT requires the use of the Sterilization Consent Form (PM 330).
  • Refer to the Sterilization section of the Part 2 provider manual and the Benefits: Primary Contraceptive Services section of the Family PACT Policies, Procedures and Billing Instructions manual.

RAD code 0117: This procedure is payable only twice per month.

  • Ongoing education and counseling codes (any combination of HCPCS codes Z9752-Z9754) can only be billed twice in 30 days, per recipient, per provider.
  • Medical record documentation must reflect scope of services provided.

RAD code 9516: Secondary diagnosis code is missing or invalid for procedure code.

  • Verify that the secondary diagnosis code is valid for the procedure code being billed.
  • Review the Clinical Services Benefits Grid in the Family PACT provider manual.
  • Call the Telephone Service Center (TSC) for assistance at 1-800-541-5555.

RAD code 9518: The Referring provider must be a Family PACT certified provider.

  • Verify that the referring provider is enrolled as a Family PACT provider.

RAD code 9887: The service being billed is not payable when billed with an infertility diagnosis.

  • Please refer to the Family PACT Program Overview section in the Family PACT Policies, Procedures and Billing Instructions Manual for assistance.
  • Call the TSC for assistance at 1-800-541-5555.

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