When billing to secondary insurance, if the CPT code originally billed to primary is not recognized by the secondary can you change the CPT code?
I believe that link is about how to request a change to the definition or description of a CPT code by the AMA.Ok, I just found this about cpt code changes https://www.ama-assn.org/practice-management/cpt/code-change-instructions
Hello-You should never change a procedure code even if it is not recognized by a secondary insurance as this constitutes fraud. Providers are paid by the services they perform so if you change the CPT code that could mean the provider would be paid more or less for that procedure. If the procedure code that was originally billed to the primary is not recognized by the secondary insurance there are modifiers that you can add to the procedure code when billing the secondary insurance.
I never change anything on a secondary claim.Hello-
For Telehealth claims, when the secondary payer requires a different POS type than the primary payer (ex: Medicare wants typical POS (11, 22, etc) and BCBS wants POS 02)...is it fraudulent to change the POS type to what the 2ndry plan requires on the 2ndry claim? I think it is, but I can't find any documentation to support that it is or isn't...especially not with the flexed guidelines for COVID claims.
That link is to what is now a very outdated article. It seems to have been written mid-March, and the rules changed 20 times since then.Everything I am seeing between primary or secondary payers says to use place of service 2. They also say to use one of two modifiers GQ or 95 with the appropriate CPT code.
https://capturebilling.com/telemedicine-billing-tips/
I will respectfully disagree with the above answer. There are insurances who will instruct you to change the CPT code. If their computer systems don't have the CPT code, it isn't going to get paid by adding a modifier. Bill it on paper, with the EOB.
Hello, I wonder if you have or know where I can find something in writing stating this. I am setting up a policy for our department and need to include something on this.You should never change a procedure code even if it is not recognized by a secondary insurance as this constitutes fraud. Providers are paid by the services they perform so if you change the CPT code that could mean the provider would be paid more or less for that procedure. If the procedure code that was originally billed to the primary is not recognized by the secondary insurance there are modifiers that you can add to the procedure code when billing the secondary insurance.
Did you ever get any answer on this? I am trying to figure this out as well. ThanksWith the suggestion to bill paper with the EOB, the EOBs still do not match and we are getting rejected as noncovered or invalid CPT. Example is Medicare UGS primary and commercial secondary. We are an FQHC and we need to bill Medicare with G2025, but commercial wants us to bill with an E/M and a modifier. How do we go about this?
Thank you in advance.
Leslie Pou
Aloha! Have you found a resolution to this? I work for an OTP and we are getting the same denials. We bill G2067 to Medicare, but secondary Medicaid is denying as procedure code is not recognized... Would love to hear some feedback. Thank you!With the suggestion to bill paper with the EOB, the EOBs still do not match and we are getting rejected as noncovered or invalid CPT. Example is Medicare UGS primary and commercial secondary. We are an FQHC and we need to bill Medicare with G2025, but commercial wants us to bill with an E/M and a modifier. How do we go about this?
Thank you in advance.
Leslie Pou