CMS "Pause" on Downcoding
CSRO has been working with the Center for Program Integrity (CPI) at CMS on the complex vs therapeutic coding and billing issue.
CMS (CPI) is aware that, despite its technical direction to pause the "downcoding" of Cimzia® (J0717), Orencia® (J0129), Simponi Aria® (J1602), Stelara® (J3358), and Prolia® (J0897), the MACs continue to reject claims when the complex administration codes are submitted. They are looking into why this is happening and CSRO will send out an update once additional information is known.
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