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Back  RFI # 1978: 278 Procedure Code Question

Formal vs. Informal Help Informal Formal

Submitter

Teresa Bonesteel

Description

Can a payer display or respond with additional procedure codes over and above the procedure code submitted on the X12 278 request?

We have a scenario where a behavioral health provider could send in one code on a (278) Service Authorization request (or enter it on the web portal), however there are 3 codes that the provider may bill under, not necessarily the code that was used to set up the SA.

Can the payer respond with the additional procedure codes (or display them) back to the provider?

Submitter Assigned Keywords

278 procedure code

Response

There is nothing in the guide that would prevent the ability to return a response with additional procedure codes even if these codes were not included in the original request. This offers the flexibility to return the decision outcome for the codes requested and/or the ability to return additional codes that should be considered “Modified” since they were not included with the original request, or substituted for codes that were submitted.
Submission 10/2/2014
Status Date 1/20/2015
Status F - Final
Primary References
Document 005010X217
Section1.1