Claims Reprocessing of Procedure Code 57295

Information posted October 16, 2009: TMHP has identified an issue with claims that were submitted by physicians, ambulatory surgical centers, and hospitals with dates of service from January 1, 2006, through October 6, 2009, and procedure code 57295. Claims that were submitted with procedure code 57295 and diagnosis codes other than 25520, 25541, or 25542 may have been denied in error. Effective for dates of service on or after January 1, 2006, procedure code 57295 is no longer diagnosis-restricted.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.