The following Release 4 changes are being implemented on July 1, 2023, with an effective date of April 1, 2023.
G550A – Pessary Care
G550A is eligible for payment for the same patient, any physician, 6 times per 12-month period. Services in excess of the limit will pay at $0 with explanatory code ‘D6 – Limit of payment for this procedure reached’.
G550A is not eligible for payment on the same service date, to the same patient, by any physician as G398A.
- If G550A and G398A are submitted on the same claim, G398A will pay in full and G550A will pay at $0 with explanatory code ‘D7 – Not allowed in addition to other procedure’.
- If G550A and G398A are submitted on separate claims, the first fee code submitted will approve for payment and the second will pay at $0 with explanatory code ‘D7 – Not allowed in addition to other procedure’
Please note, G550A is not eligible for payment under Virtual Care. G550A submitted with a modality indicator of K300A or K301A will pay at zero dollars with explanatory code ‘B8 – Service Not Eligible for Payment Virtually’.
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