Codes Changed to E1399 for Cures Act Adjustments

CGS and Noridian DME MAC jurisdictions are processing thousands of claims on a daily basis in accordance with MLN Matters Article MM9968. The jurisdictions reported that they are on track to have all adjustments processed by November 15.

Suppliers with oxygen claims covered under these mass adjustments may see miscellaneous code “E1399CC” on some Medicare Remittance Advice statements. Due to system limitations, the code E1399 is being used when previous oxygen CMNs have been deleted and are no longer on file due to a new CMN superseding the previous CMN. HCPCS code E1399 was used since it will not impact current or future oxygen claims. The “CC” modifier also signifies that the HCPCS was changed during processing.

Further, both CGS and Noridian DME MAC jurisdictions have published that in order to process the wheelchair accessories claims adjusted by the Cures Act, in some cases, the DME MAC jurisdictions may need to change the submitted HCPCS code to E1399 with a “cc” modifier. This step is needed to pay the correct amount. There are various billing and modifier rules that cannot be accommodated with the limitation of four modifiers for pricing and system edits on the submitted wheelchair accessory HCPCS. The best solution is to change the HCPCS to E1399 with a “cc” modifier.