Medicare Administrative Contractor (MAC), Palmetto, has advised ASTRO that a coding issue in which simulations (CPT 77290) and 3D plans (CPT 77295) were rejected, particularly in breast cancer cases, has been resolved. Members had been experiencing inappropriate claim rejections for these codes from Palmetto and other Medicare Advantage (MA) plans in that region.

The Palmetto system is currently being updated to remove a particular “Smart edit,” which should alleviate future rejections for these codes. Palmetto has asked practices to wait until after July 22, 2024, before refiling any rejected claims, to allow time for this update to be completed.

Practices will need to review their 277CA report to identify the most current claim for each rejection instance. Once those claims have been identified, practices will need to perform exact resubmission, i.e., no corrections or revisions to the claim/s. If a practice has multiple claims for the same beneficiary/same date of service which have been rejected more than once, the 277CA report should point to the practice to the most current claim. Practices that continue to experience claims processing issues after the July 22 update should reach out directly to Palmetto.