Forum - Questions & Answers

Dec 2nd, 2010 - jschmutz   323 

2011 CPT® Codes Effective for Use

Can anyone provide me with proof that the 2011 CPT® codes can't be used until 1/1/2011?

Medicaid of Utah is denying 2010 CPT® codes stating that they want the 2011 CPT® code used instead.

64573 is being denied, because they want us to use 64568.

64573 will be deleted as of 1/1/11 -
64568 will go into effect as of 1/1/11

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Dec 2nd, 2010 -

Proof of a negative is difficult

Medicare just published a Med Matters about the new flu CPT® codes and it states:

For dates of service on or after October 1, 2010, HCPCS codes Q2035, Q2036, Q2037, Q2038 and Q2039 (as listed in the table above) will replace the CPT® code 90658 for Medicare payment purposes during the 2010 – 2011 influenza season. However, these HCPCS codes will not be recognized by the Medicare claims processing systems until January 1, 2011, when CPT® code 90658 will no longer be recognized.

How is that for double talk- the codes are replaced Oct 1st but not valid until Jan 1st. New codes are generally effective October 1st

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Dec 3rd, 2010 - jschmutz   323 

To make things more confusing...

I came across this....

Page x, paragraph 3 of the introduction in the CPT® 2011 book. The AMA does say in their July 2010 Cat II & III Updates Documents that carriers may have their own implementation dates so I would guess that goes for Cat I as well and I’m sure can be found on their site somewhere. Here is the excerpt from the Cat I & II updates from the summer.

Within this document, the term “release date” is intended to identify the date of publication of the noted change by the American Medical Association (AMA). The term “implementation date” is intended to identify the date that the change officially becomes a part of the CPT® code set. Please note that payers may use the term “implementation date” or “effective date” to specify the start date for use of a code in a designated program (eg, PQRI). Start dates may vary from payer to payer and may differ from the AMA implementation dates. Therefore, check with the payer for specific payer information regarding use of these codes as part of any program.

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