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Retroactive Reimbursement on Medicaid Claims


Primary care service codes according to the ACA increase

Primary care services designated in the Healthcare Common Procedure Coding System (HCPCS) are as follows:

(1) Evaluation and Management (E&M) codes 99201 through 99499 (currently covered by Medicaid).

(2) Current Procedural Terminology (CPT) vaccine administration codes 90460, 90461, 90471, 90472, 90473 and 90474

Physicians MUST attest on or before May 31, 2013, in order to receive retroactive reimbursement for the above CPT codes for dates of services beginning January 1, 2013.  Physicians who self-attest after May 31, 2013 are eligible for the increase on the first day of the month of self-attestation, and may adjust claims retroactively to the first of the month.

Physicians who complete the self-attestation process prior to May 31, 2013 will be eligible for the rate increase retroactively to January 1, 2013.  The Medicaid fiscal agent will complete a one-time reprocessing of claims after May 31, 2013 for dates of service on or after January 1, 2013.

Please note: Physicians who self-attest after May 31, 2013 are eligible for the increase on the first day of the month of self-attestation, and may reprocess/adjust claims retroactively to the first of the month.


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