Claim Payment Alerts
| Date Reported | Provider Type Impacted | Reason Codes | Claim Coding Impact | Description of the Issue | Action Required by the MAC | Action Required by the Provider | Proposed Resolution/Fix | Status | Date Resolved |
|---|---|---|---|---|---|---|---|---|---|
11/20/2025 |
Suppliers submitting claims for HCPCS codes related to nebulizer drugs with the KO modifier. |
N/A |
J7605KO, J7606KO, J7608KO, J7613KO, J7614KO, J7626KO, J7631KO, J7639KO, J7644KO, J7682KO, J7686KO. |
Claims with a receipt date of 10/01/2025–11/21/2025 with dates of service 10/01/2025–11/21/2025 for nebulizer drugs with the KO modifier may have processed with the incorrect fee amount. |
CGS will reprocess claims that processed with the incorrect drug fee based on the CMS quarterly average sales price (ASP) files. |
No action needed. |
Claims processing errors will be corrected, and measures have been implemented to prevent future occurrences. |
In Progress |
|
02/01/2019 |
Suppliers of HCPCS codes E1020, E1028, E2368, E2369, E2370, E2375, K0015 and K0070 |
96 |
E1007, E1020, E1028, E2228, E2368, E2369, E2370, E2375, K0015 and K0070 |
Claims for HCPCS codes E1020, E1028, E2228, E2368, E2369, E2370, E2375, K0015 and K0070 may have denied incorrectly due to a system processing issue. NOTE: This is an ongoing issue with no ETA for resolution. |
The issue causing the claim processing error cannot be corrected at this time. |
No action required. |
A report will be run monthly and claims will be adjusted if the denial was incorrect. |
NA |
NA |
02/01/2019 |
Suppliers of wheelchair accessories. |
151 |
Wheelchair accessory HCPCS codes. |
Claims for wheelchair accessories may have denied as same or similar equipment incorrectly due to a system processing issue. NOTE: This is an ongoing issue with no ETA for resolution. |
The issue causing the claim processing error cannot be corrected at this time. |
No action required. |
A report is run monthly, and claims are adjusted if the accessories were denied incorrectly. |
NA |
NA |
Updated: 11.26.2025

