Apple Health (Medicaid) Provider Alert
Attention Hospital providers:
What you need to know?
For dates of service January 1, 2020, through June 30, 2020, the following procedure codes were published incorrectly in the Outpatient Prospective Payment Systems (OPPS) fee schedule, the Emergency COVID-19 fee schedule, and in ProviderOne with the nonfacility fee instead of the facility fee.
99421 99422 99423 99441
99442 99443 G2012
What have we done?
On July 1, 2020, we corrected the fee schedule and ProviderOne to reflect the facility fee for these procedure codes.
What do you need to do?
Providers do not need to do anything. This is an informational notice.
If you have already billed us for these procedure codes, please do not rebill. We will do a search for all claims during this time period that have billed these procedure codes and if they have been paid incorrectly, we do a mass adjustment.
How do I find the Outpatient Hospital Fee Schedule?
The Outpatient Prospective Payment System (OPPS) fee schedule is located on our Billers, providers, and partners web page, provider billing guides and fee schedules, under Outpatient Hospital.
For COVID-19, we created a special fee schedule. It is located on our Billers, providers, and partners web page, provider billing guides and fee schedules, under the accordion folder titled COVID-19. It is best to check that fee schedule for all fees related to COVID-19 before checking the OPPS fee schedule.
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