US · guidance
CMS Pub. 100-04, ch. 18, § 10.4.3
CWF Crossover Edits for A/B MAC (B) Claims
When CWF receives a claim from the MAC (Part B), it will review Part B outpatient claims
history to verify that a duplicate claim has not already been posted.
CWF will edit on the beneficiary MBI number; the date of service; the influenza virus
procedure codes 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662,
90672, 90673, 90674, 90682, 90685, 90686, 90687, 90688, 90694, or 90756; the
pneumococcal procedure codes 90670,90671, 90677, or 90732; and the administration code
G0008 or G0009.
CWF will return a specific reject code for this edit. MACs (B) must deny the second claim and
use the same messages they currently use for the denial of duplicate claims.
History
(Rev. 11355; Issued:04-14-22; Effective:05-16-22; Implementation:05-16-22)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e9014fa2a078268df9a0721caf8aadc6f093e55caa68942379a99b30cef66f60
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