The Centers for Medicare & Medicaid Services (CMS) has extended the temporary holding for screening Pap smear claims containing HCPCS code Q0091 for outpatient prospective payment system providers until the new outpatient code editor software is implemented on January 5, 2009.

The Internet-only manual, Pub. 100-04, chapter 18, section 30.5, states that coinsurance is applied to claims for screening Pap smears containing HCPCS code Q0091 when this service is provided in skilled nursing facilities (SNFs), federally qualified health centers (FQHCs), rural health clinics (RHCs), hospitals, and critical access hospitals (CAHs).

CMS has notified fiscal intermediaries that due to the fiscal intermediary shared system (FISS) processing error, coinsurance is not being applied to screening Pap smear claims containing HCPCS code Q0091, when these services are provided in hospitals (type of bills 12x, 13x, and 85x), for dates of service on and after April 1, 2008.

Currently, FISS is making system changes to correct this issue. Until the system changes are implemented on January 5, 2009, First Coast Service Options Inc. (FCSO) is holding the affected claims in location ST/LOC SMSPRQ under reason code 75019.

FCSO will release the affected claims for processing on January 5, 2009, once the system changes are implemented.