Physical therapists who receive rejection codes H20203 and/or H45255 on claim forms will need to balance bill their patients' supplemental payers for any balances left after Medicare, according to recent instructions from the Centers for Medicare and Medicaid Services (CMS) that state that this issue is expected to affect a limited number of providers. (Scroll down to article titled "Providers who Receive Error Codes H20203 and H45255 Need to Balance Bill" for details.)
On February 29, CMS alerted Medicare providers and suppliers to 3 edits that they may see on special provider notification letters that they receive from their local Fiscal Intermediary (FI), Carrier, A/B Medicare Administrative Contractor (MAC), or Durable Medical Equipment MAC (DME MAC). These edits had resulted, or are still resulting, from defects within CMS' coordination of benefits (COB) HIPAA 837 compliance editing. The defects associated with edits H51108 and H20203 at the Coordination of Benefits Contractor (COBC) were resolved on January 16 and February 27, respectively.
CMS has released the following additional information regarding edits H20203 and H45255: