1. L

    Question Medical Necessity / ABN forms

    Hello! Our provider did an I&D (10060) to treat a subaceous cyst (L72.3) on a patient who has Medicare. Per our provider, the cyst was not bothering the patient (ie, it's not painful or rubbing on clothing, etc) and she treated it at the patient's request because he didn't like the way it...
  2. S

    ABN required for E0935 (CPM)?

    Hello, I need clarification on the ABN requirement for a CPM machine where the patient has not had a total knee replacement. The CGS Medicare Jurisdiction C Supplier Manual states "ABNs are not required for care that is either statutorily excluded from coverage under Medicare (i.e. care that...
  3. K

    HELP! Medicare G Modifiers: When to use which one?!

    Hello, I work in a public health agency and our contract with Medicare is as a immunization roster biller only (we can only bill/receive payment for Influenza and Pneumococcal vaccines). Since we are a public health agency, we do not turn away a patient with Medicare if they want something other...
  4. H

    ABN forms

    With all of the changes in pain medicine management, our practice will start billing for the urine drug screens (80305). CMS does not currently pay for this so we are considering having the patient's sign an ABN form to cover the cost of the cup. Is anyone in the same situation? The LCD is vague...
  5. A

    UHC Medicare Solutions denying PPD

    We are currently having an issue with UHC Medicare Solutions denying our claims for 86580 (PPD) with diagnosis code Z11.1. They are not dropping it to patient responsibility. They are telling us we must write it off. In conversations with them, they are saying we must get an ABN signed so...
  6. D

    Medicare/Medicaid secondary: HCPCS services non covered by Medicare paid by Medicaid

    Hi, I work for a community mental health center and most of our services that we render are HCPCS and covered by Medicaid. My question is: Since the services are not covered by Medicare do we bill Medicaid directly or do we still need to bill Medicare as primary? I have asked this question...
  7. S

    Commercial Insurance ABNs

    What are the general rules regarding the use of ABNs for commercial insurance plans? If the insurance company denies payment for a service with a CO (Contractual Obligation) code, can we still bill the patient if they have signed an ABN in advance? Thanks for the input!
  8. J

    ABN/modifiers/moderate sedation

    I understand the following to be a question to and response from the AMA about time in moderate sedation: _______________________________________________________________________________________________________________________ Question: Is it appropriate to report the moderate (conscious)...
  9. D

    Medicare ABN Question

    Can anyone tell me if a Medicare ABN must be signed on the date of service? We give home hemoccult tests that the patient takes home and then brings back or mails back to our office. Can an ABN be signed on the date the test is given to the patient? Or must it be signed on the day the test is...
  10. C

    GA modifier change and GX modifier

    Effective April 1, 2010 CMS is implementing the GX modifier. With the addition of the GX modifier, all claims for hospitals/facilities with GA modifier on them will deny as patient responsibility without going through Medicare's processing, specifically a medical necessity check. Is anyone...