Codes G0461 & G0462 Denying in Error

October 17, 2014

Denials caused by missed update to the Skilled Nursing Facility (SNF) consolidated billing code edit lists

By Ann Lambrix
Executive Client Administrator
Vachette Pathology

Yes folks, another issue with the G0461 and G0462 codes. Providers have seen denials for these codes stating “claim/service not covered by this payer/contractor.  You must send the claim/service to the correct/payer contractor, indicating the charges should go through SNF consolidated billing.”

Per CMS Part B MAC update:

NOTE:  Certain Healthcare Common Procedure Coding System (HCPCS) codes were not included in the 2014 annual update to the SNF consolidated billing code editing lists. A correction to the coding lists will be implemented in October, 2014. The affected HCPCS codes for practitioner billing are Q2050, (which will be added to File 1), and the professional component of G0461 and G0462 (which will be added to File 2). If you have claims with dates of service from January 1 through September 30, 2014, that have been erroneously denied, you should contact your Medicare Administrative Contractor to have the claims re-opened and re-processed.

Ann is the Executive Client Administrator at Vachette Pathology, your go-to source for auditing, practice management and industry updates and changes. Visit more of our news updates at or call us at 517.486.4262.

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