2022-11: System Errors on Claims with CPT Code 81220

Date: 05/02/22

We are working quickly to resolve the issue with no action needed by healthcare providers. 

We are experiencing system errors on claims with the CPT code 81220, affecting 2,444 claims. We apologize for any inconvenience and are working to resolve the issue quickly, and with minimal disruption for healthcare providers. 

What happened?

Prior to 7/1/2021, CPT Code 81220 was covered for pregnant mothers in certain circumstances when deemed medically necessary per our clinical policy, LA.CP.MP.83 - Carrier Screening in Pregnancy. This policy was retired in June 2021. It was recently identified that 2,444 claims with dates of service on or before the policy was retired were inadvertently denied. 

What are we doing about it?

We are automatically recycling these claims and they will be paid as appropriate. Denied claims for dates of service on or before 7/1/21, which met the medical necessity criteria outlined in LA.CP.MP.83 - Carrier Screening in Pregnancy, are being recycled under two separate projects. The two projects are: PROJ-279411868 for claims billed on UB-04; and PROJ-279426829 for claims billed on CM51500. All claims will be recycled no later than 5/27/2022.

What do providers need to do?

No action is required on the part of the provider to have these claims recycled. All relevant claims will be automatically recycled no later than 5/27/2022.