Medicare Pet Processing Error Causes Overpayments

There has been a sudden spike in Medicare payments for PET studies. Change Request (CR) 6973 was released to Medicare contractors on May 10, 2010 but, due to an oversight when CMS created the new files, there were some entries to the files that caused PET procedures to be overpaid.

Specifically for CPT codes 78811-78816, 78508, 78459, 78491, 78492 the file did not contain the CMS capped rate, causing CMS to over pay for these services since May 24, 2010. A temporary fix was installed on June 3, 2010 to avoid additional overpayments from being generated on claims received June 4, 2010 to July 5, 2010.

CMS plans on correcting the fee schedule file on July 6, 2010. Once all the claims that generated the overpayments have completed processing, CMS will initiate the overpayment recovery (for the codes mentioned above).

ADVOCATE will continue to provide updates as they become available.

With best regards,
Kirk Reinitz, CPA