CPT CODES 99201 THROUGH 99205

January 4, 2012

Background Information:
Palmetto GBA recently denied some claims for new patient office visits (CPT Codes 99201 through 99205) when they were performed by a physician assistant or a nurse practitioner with specialty codes 97, 89 and 42. We are correcting this situation and will perform a mass adjustment on the claims that were denied in the near future. There is no need to submit an appeal for these denials.
This affected claims starting with the following cycle dates for the areas indicated:
NCA/HI/NV: November 30, 2011
SCA: December 6, 2011
Applies To Procedure Codes:
99201
99202
99203
99204
99205

Remark/Reason Codes:
B16 ‘New Patient’ qualifications were not met.

MAC Action:
Palmetto GBA will reprocess these claims.

Provider Action:
None Required – Palmetto will mass adjust claims.

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