Wiki 51798 Medicaid Denials

[sstep]

Hi

Is anyone else getting denials for 51798 from Medicaid when billing with an office visit? We have billed both with and without the modifier 25 on the office visit and are not able to get this paid

Any help would be appreciated!

Thank you

 

[lcole7465]

I'm looking for an answer also

Hi

Is anyone else getting denials for 51798 from Medicaid when billing with an office visit? We have billed both with and without the modifier 25 on the office visit and are not able to get this paid

Any help would be appreciated!

Thank you

I'm looking for an answer also. I have many denied as Outpatient/Office visits.

 

[Brooke_cale]

We experience this as well. So far we have had success in payment by modifying with a -59 (audits be darned..sometimes they are necessary to get through payer edits)

 

[kat22875]

Has anyone found a way to get CPT 51798 paid with an E&M office visit?

 

[liqgold2@aol.com]

There are several carriers that consider 51798 as part of an office visit and will not pay separately for this service. It is interesting that some have paid when appending modifier-59 to 51798. Check with the carrier if this is ever paid with an office visit.