May 2004 Newsletter

HCPCS Grace Period Gone

By: Janet Browning, Quality Assurance

CMS - Elimination of 90-day Grace Period for HCPCS Codes for 2005

Medicare has traditionally allowed a 90-day grace period after the annual January 1 implementation of an updated version of the Healthcare Common Procedure Coding System (HCPCS). During this 90-day grace period providers could use either the previous or the new HCPCS codes. For claims received on or after April 1, the updated procedure codes were required.

Due to HIPAA standards, which require the use of national code sets that are valid at the time that the service is provided, CMS can no longer allow the 90-day grace period. Effective for dates of service on and after January 1, 2005, Carriers, DMERCs, and fiscal intermediaries (FIs) will no longer be able to accept discontinued codes for dates of service January 1, 2005 through March 31, 2005.

Quadax will be updating our edits to edit electronic claims against the new 2005 codes, effective with dates of service January 1, 2005 and after. As of this month, only CMS has announced the elimination of this grace period. [Editor's note: as of October 2004, most Blue Cross/Blue Shield carriers have published their plan to follow this CMS directive.] We are monitoring other payers to see if they will also be following these guidelines.

Providers can purchase the American Medical Association's Current Procedural Terminology, 4th Edition ("CPT-4 book") that is published each October that contains new, revised and discontinued procedure codes for the upcoming year. In addition CMS posts on its web site the annual alphanumeric HCPCS file for the upcoming year at the end of each October.

Other articles this quarter by Janet Browning: ICD Grace Period Gone, Claims' Supporting Doc.