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Changes in Bypass Payment Edits (3-days and 1-day) For Donor Post-Kidney Transplant

The MACs to implement logic that ensures they bypass payment window edits (3-days and 1-day) when processing claims for donor post-kidney transplant complications services. MACs will hold certain claims, as noted below, until Medicare's Common Working File (CWF) system edits these claims correctly.

3-Day Payment Window Edits:

  • 7109: Outpatient Diagnostic Service against Inpatient in history
  • 7113: Inpatient against Outpatient Diagnostic Service in history
  • 7114: Outpatient Therapeutic Service against Inpatient in history
  • 7115: Inpatient against Outpatient Therapeutic Service

1-Day Payment Window Edits:

  • 7119: Outpatient Diagnostic Services against Inpatient in history
  • 7120: Inpatient against Outpatient Diagnostic Services in history
  • 7121: Outpatient Therapeutic Services against Inpatient in history
  • 7122: Inpatient against Outpatient Therapeutic Services in history
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