The American College of Cardiology and the Managed Care Advisory Group want to remind you that if you have not already done so, now is the time to resubmit for separate payment of 12 Lead ECG interpretations (CPT 93010) under the Humana Settlement negotiated by the American College of Emergency Physicians (ACEP).
Under the Settlement, Humana will make eligible for payment resubmitted claims with dates of service from October 1, 2009 through March 31, 2010 for Electrocardiograms (EKG) 12-Lead service (CPT code 93010) when billed with the following E&M codes (CPT Codes 99217,99218, 99220, 99234, 99235, 99236, 99281-99285, 99291 and 99292) with or without the appending a Modifier 25 to the E&M Code (hereinafter “Claims”).
After a formal compliance dispute filed by ACEP in 2009, Humana has ceased bundling claims for CPT 93010 (12 lead ECGs) diagnostic interpretations when reported with the E&M codes above as of April 16, 2010 (Effective Date). Humana will reimburse one professional interpretation as of the Effective Date and the first claim received for 12 ECG will be reimbursed. In addition to the prospective relief, ACEP negotiated for the lifting of the edit going forward as a primary goal.
Physicians have up to and including February 28, 2011 to resubmit these claims. Resubmitted claims received by Humana after this date will not be reprocessed.
The following fields will need to be provided:
Provider Name
Provider Tax ID # (TIN)
Member Name
Member ID
Patient Name
Patient Date of Birth
Date of Service
E&M CPT code billed with CPT Code 93010
Billed Amount (for the 93010)
Based on the Aetna settlement for payment of ECGs, also negotiated by ACEP, payment for CPT code 93010 typically ranges between 10 and 15 dollars, so this can mean significant incremental reimbursement for your group.
Managed Care Advisory Group is ready to assist with filing. They can be reached at 800.355.0466, or at physicianservices@mcaginc.com. More information and documentation can be found at the following website http://www.acep.org/Content.aspx?id=50396.