The Centers for Medicare and Medicaid Services (CMS) recently indicated that Medicare Administrative Contractors (MACs) have returned some institutional, outpatient physical and occupational therapy or speech-language pathology claims with reason code W7072 in error between January 1 – June 30, 2023.
The MACs will not automatically reprocess these claims. Provider billing staff should resubmit claims that were returned in error.
These claims include:
- CPT codes: 98980, 98981 (either or both)
- CPT code 98980 ─ Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes
- CPT code 98981 ─ Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure)
- Revenue codes: 42x, 43x, or 44x
- Type of bill:
- 22X or 23X: skilled nursing facilities
- 34X: home health agencies
- 85X: critical access hospitals