Override Code in Medicare

Original Medicare

To address inappropriate denials of coverage, the Center for Medicare and Medicaid Services (CMS) has approved a special billing code (condition code 45) to assist processing of claims under original Medicare (Parts A and B). This billing code should be used by your physician or hospital when submitting billing claims for services where gender discrepancies may be a problem. When used with standard billing codes doctors use for specific procedures, this code alerts Medicare’s computer system to ignore an apparent gender discrepancy and allow your claim to be processed. Details are explained in the Chapter 32 of the Medicare Claims Processing Manual (see instructions in last post).

Have talked with Mara Keisling of NCTE National Center of Transgender Equality, and she is working to make sure all the Regional Directors know about this code change.